Dr. Chapa’s OBGYN Clinical Pearls

The latest updates to the CDC's birth control guidelines are finally here! Discover the implications for hormonal methods and the safety of contraceptives in specific populations. Key discussions include changes regarding migraines with aura and IUD placements in postpartum scenarios. The expert insights shed light on how these recommendations will impact patient counseling and health advocacy efforts. Stay informed on the evolving landscape of contraceptive recommendations!

The podcast highlights groundbreaking advancements in non-hormonal treatments for hot flashes, focusing on Elizinidat, pending FDA approval. Listeners learn about its unique dual mechanism and how it compares to the established Veozah. With insights from the OASIS clinical trials, the discussion blends innovative medical research with cultural references, emphasizing the importance of supporting women's health during menopause. A playful parody adds humor while addressing the serious challenges women face.

Artificial Intelligence is reshaping maternal healthcare, particularly in predicting stillbirth rates. The UK’s TOMMY APP is a notable development, aimed at reducing preterm births. A recent systematic review sheds light on machine learning's capabilities in stillbirth prediction, a crucial topic in light of new legislation in the U.S. Advances in AI promise to enhance fetal monitoring, while also underscoring the challenges it presents. Dive into the fascinating intersection of technology and obstetrics!

A recent study links maternal obesity to an alarming increase in Sudden Unexpected Infant Death (SUID), elevating concerns even after a baby’s discharge from the hospital. The discussion emphasizes the emotional toll on families, especially those facing socioeconomic challenges. Attention is drawn to the importance of compassionate care, nutritional education, and parental awareness regarding co-sleeping. With obesity rates on the rise among pregnant women, proactive health measures are advocated to reduce these risks and promote healthier outcomes.

Discover groundbreaking advancements in the management of alloimmunized pregnancies. Learn about the newly updated ACOG guidelines that emphasize the role of paternal and fetal genotyping. Delve into the use of cell-free DNA testing as a non-invasive tool for fetal red blood cell antigen detection. This update illustrates how quickly the medical field evolves to enhance care for high-risk pregnancies!

In September 2022, a cell-free DNA assay using next-generation sequencing and quantitative counting tech for fetal antigen status determination became clinically available in the USA. This allowed maternal screening for fetal RBC genotypes for RH negative patients. This test was recognized by thre ACOG in March 2024 as one option to “triage” anti-D immunoglobulin in RH negative women. But can this technology be trusted in alloimmunized patients? In women with antibodies against foreign antibodies, this cell free DNA fetal screening option MUST get it right. We now have that data. In this episode, we will summarize remarkable results, published ahead of print on July 25, 2024 in the Green Journal. This study is a win for science and prenatal care. Listen in for details (BillontoOne, Inc is not a sponsor for this podcast).

First off, let’s all agree that everyone has a different STYLE of sexual intimacy, and that’s OK. Yep, we all understand that there's always been a lot of sexual act “diversity” in the world… and throughout history. But there is a more recent trend that has increased in popularity, some surveys attribute it to its representation in pornography, that may be dangerous. This was in recent print as of July 3, 2024! This is "sexual choking”. But this term is not accurate because it actually is a form of strangulation. The increase in practice is mostly seen in teenagers and young adults. In this episode, we will discuss a real-world scenario that one of our podcast family members asked me about just the other day. This OBGYN physician was on call and one of her patients, a 21-year-old, non-pregnant, otherwise healthy, and THIN (yes, that was a factor in this case, and we will discuss why) presented with LOC during sex whose partner stated “she had a seizure” during sex. But this was no ordinary seizure. She had no history of epilepsy and was not on any medications. The “seizure” happened after sexual choking. Sexual choking is a big concern as it exposes the brain to recurrent episodes of hypoxia. We now have data showing there are real negative effects from this activity. Plus, we need to discuss this as it may also be a normalization, inappropriately, of sexual violence. In this episode, we will take a look at this alarming data and discuss why we need to ask about these sexual practices in a compassionate, empathic, and open way.

Candida in women is being right? Afterall, vulvovaginal candidiasis during pregnancy is common. Candida species may be isolated from the vagina of 15 %-21% of nonpregnant women; this rate increases to 30% during pregnancy. While it is generally benign and isolated to the vagina clinically, some Candida species have the capacity to be troublemakers. C. Glabrata has the potential to be a bad player, with the possibility of invasive disease. Candida IAI is rare but can lead to neonatal infection, high mortality, preterm prelabor rupture of membranes, and childhood neurodevelopmental impairment. The most prevalent predisposing condition is preterm prelabor rupture of membranes, followed by intrauterine pregnancy with a retained intrauterine contraceptive device, cervical cerclage, diabetes in pregnancy, and pregnancy after in vitro fertilization. Preterm labor is the most common symptom with Candida IAI, and only 13% of cases involved fever. Case reports have also associated C. Glabrata with third trimester stillbirth. Although case reports have documented this since the 1980s, this is still an evolving diagnosis as awareness of the condition increases. Nonetheless, the clinical features of Candida IAI are not well understood, and best management of the condition is unclear. In June 2024, Candida Glabrata was called a “global priority pathogens”. In this episode, we will review this rare but very real clinical conundrum. One of our podcast family members actually managed a patient, s/p IVF, with periviable PPROM found to have Candida Glabrata fungemia. How is this possible? Shall we treat Candida in the urine? We will discuss this in this episode.

The podcast explores the new PreTRM biomarker test for predicting preterm birth in low-risk patients, comparing it to existing biomarker tests for conditions like preeclampsia. It discusses the promising aspects and limitations of the AVERT Preterm Trial utilizing the IGFBP4/SHBG biomarker ratio, alongside the controversy surrounding vaginal progesterone use for preventing preterm birth.

The podcast discusses the safety and efficacy of misoprostol and prostaglandin E2 for cervical ripening. It explores the sequential use of cervical balloons after misoprostol and vice versa. Audience questions on clinical topics like PPROM, in vitro status, and fever are also discussed.