Dr. Chapa’s OBGYN Clinical Pearls

Explore the complexities of cesarean scar pregnancy, a rare yet serious condition linked to previous C-sections. Discover the vital role of early ultrasound in diagnosis and the various risks, including uterine rupture and severe bleeding. Learn about the importance of collaborative care among specialists for effective management. The podcast delves into evolving terminology and professional guidelines, emphasizing the need for precise treatment methodologies in these high-risk pregnancies.

(DISCLOSURE: Sexual Content) Back in April 2023, we released an episode on the “Jade Vaginal Egg” and vaginal weights for vaginal tightening. While we tackled the Jade Egg successfully, we now have a new player on the field: the VAGINAL TIGHTENING STICK. This over the counter “sex aid” can lead to chemical burns and severe vaginal dryness/agglutination. Marketed to improce vaginal laxity, some of these sticks have the real potential to cause tissue damage and scarring- as one of our podcast family members saw firsthand with a patient. Its an interesting market place out there! Listen in for details.

The IUD is a very safe and supremely effective contraceptive method. Given its increasing rate of use, practitioners are bound to see its relatively infrequent complications with greater regularity. Typical complications are considered “lost strings“, uterine perforation at placement, and expulsion. But there is another complication, device FRACTURE at removal. This can cause distress to the patient and can lead to additional interventions. Fracture of an intrauterine device (IUD) upon removal is a very rare complication, with a prevalence rate of 1–2%. However, the numbers have been rising since 2021, causing the FDA to track these complications. There has even been a bizarre case report of the copper coils being found in the pelvis WITHOUT device fracture! How?? In this episode, we will describe and review this relatively recent issue, its diagnosis, ways to minimize its occurrence at removal, and management strategies.

Explore the history and guidelines of umbilical cord gas analysis, first described in 1958, as a critical tool for assessing fetal health. Hear about the debate over universal testing for all deliveries versus targeted approaches. Discover the significance of umbilical cord lactate levels in predicting newborn outcomes. Understand the importance of paired samples for accurate results, and laugh along as email etiquette and delivery practices are humorously discussed. Tune in for essential insights into neonatal care!

A game-changing self-collection swab for HPV screening is set to launch in clinical settings by August 2024. This FDA-approved kit allows women to collect samples conveniently, promoting better cervical cancer screening rates. The podcast discusses the distinctions between this new option and at-home kits, emphasizing the need for professional guidance in health evaluations. A humorous exchange between medical professionals sheds light on evolving communication styles, balancing professionalism with camaraderie in the medical field.

The rise of home testing for STIs/HIV started long before the recent pandemic (the FDA approved its first HIV home test collection kit way back in 1996), but COVID-19 seems to have accelerated the popularity of getting tested from the comfort of our homes. In Nov 2023, the Food and Drug Administration granted marketing authorization, the first of its kind, for an at-home test for chlamydia and gonorrhea. The test kit, called Simple 2, is available online through various offerings. Chlamydia and gonorrhea are the most common STIs in the U.S. Of course, syphilis has also been on the move. And now, as of August 2024, The FDA has granted new clearance to NOWDiagnostics (not a sponsor) for the first at-home, over-the-counter syphilis screening test. So now we have gonorrhea, chlamydia, and syphilis at home testing options. At home HPV swabs are also seeking entrance into the marketplace. While these options remove barriers to care and allow testing in the privacy of one’s own home, there are inherent problems balancing out each of these promises. In this episode, we will review the pros and cons of at home testing for STIs and we will discuss why this is still caveat emptor, “buyer beware”, in this new healthcare marketplace option.

The World Health Organization declared on 8/14/24 that the increasing spread of Mpox in Africa is a global health emergency, warning the virus might ultimately spill across international borders. Mpox, also known as monkeypox, was first identified by scientists in 1958 when there were outbreaks of a “pox-like” disease in monkeys. Until recently, most human cases were seen in people in central and West Africa who had close contact with infected animals. In 2022, the virus was confirmed to spread via sex for the first time and triggered outbreaks in more than 70 countries across the world that had not previously reported Mpox. Unlike in previous Mpox outbreaks, where lesions were mostly seen on the chest, hands and feet, the new form of Mpox causes milder symptoms and lesions on the genitals. That makes it harder to spot, meaning people might also sicken others without knowing they’re infected. In this episode, we will review the pathophysiology of this virus and describe its implications during pregnancy. Does Monkeypox cause adverse pregnancy issues? It’s cesarean section indicated for those affected? And is there any available treatment for active infection? Listen in for details.

A major recall has sparked concerns about Listeria contamination in ready-to-eat meats, particularly affecting pregnant women. With heightened risks for expectant mothers, the discussion delves into dietary precautions and the dangers posed by this bacteria. Listeriosis can cause severe complications like fetal loss and neonatal infections. The experts also touch upon past outbreaks and address guidelines for managing exposure, emphasizing the critical need for awareness and prevention.

Our tagline, “Medicine moves fast“, is the absolute truth! Historically, identification of fetuses at risk of hemolytic disease of the fetus/newborn (HDFN) required amniocentesis for determination of the Delta OD450, Liley Curve. This was the first screen, which would then trigger cordocentesis for determination of the fetal hematocrit. We’ve now moved on to middle cerebral artery (MCA) doppler of the fetus for identification of those at risk. Additionally, we now have an ability to ascertain antigens on the fetal red blood cells through the maternal serum (cell free DNA). That’s amazing! Nonetheless, despite these wonderful advances, HDFN can still exist. But Medicine moves fast… In this episode, we will present brand new data from the NEJM. This Phase 2 international study, published on 8/7/24, describes the use of a monoclonal antibody (Nipocalimab) to block maternal IgG passage to the child. This is a revolution in HDFN prevention. Yep, medicine moves fast! Listen in for details.

Prior to the 1970s, when component therapy became the preferred method of resuscitation, whole blood (WB) was the resuscitative medium of choice for hemorrhagic shock. In modern medicine, sometimes it turns out that the old way is better than the new…and using whole blood for transfusions is one example. Research is emerging that shows whole blood works better for these patients than fractionated components of blood. Beginning in 2017, multiple stakeholders within the Southwest Texas Regional Advisory Council for Trauma- as well as others in different states, collaborated to incorporate cold-stored low-titer O RhD-positive whole blood into all phases of their trauma system, including the prehospital care via EMS. Although the program was initially focused on trauma resuscitation, it was expanded to include non-traumatic hemorrhagic shock patients that may benefit from whole blood resuscitation when MTP is needed. What about Low Titer O Pos whole blood use for maternal MTP resuscitation? Is there data there? And what about the risk with using type O whole blood as a donor. In this episode, we’ll dive into the details.