Dr. Chapa’s OBGYN Clinical Pearls

(Here’s a WONDERFUL QI Project for this New Residency Academic Year) With 70.8% of pregnancies among adolescents being unintended, there is a clear need for increased access to contraceptive services. Many adolescents use the emergency department (ED) as their primary healthcare source, highlighting the importance of providing comprehensive sexual health services in this setting. The risk of pregnancy is high among adolescents seeking ED care, indicating an opportunity to expand pregnancy prevention services in this setting. ED clinicians are in a unique position to address pregnancy prevention among adolescents. Novel ED staff training tools kits do exist for brief contraceptive counseling interventions during the ED visit for interested adolescents who present for any chief complaint. Talking to teens about contraceptives in the ED is feasible, acceptable, and allows ED staff to reach youth that may not have access or choose not to access medical care in any other setting. In this episode, we will summarize striking data from a recent publication (June 28, 2024), in JAMA Network Open, which revealed gaps in addressing contraceptive needs among vulnerable adolescent females and gaps in provisions of EC when needed. Additionally, we will propose an easy to adopt strategy to better equip Emergency Department staff for having these conversations.

Exploration of ACOG guidelines on antibiotics for PROM without fever. Lowered fever threshold in PROM over 12 hours discussed, emphasizing early intervention for suspected intra-amniotic infections.

Podcast Family, I hope this episode gives you pause and brightens your day 🌞. Just a quick work and acknowledgement to likley our YOUNGEST podcast family member and his mother, a Co-OBGYN preparing for oral Boards. 👏👏 Let this speak to you as the message spoke to me! (and introducing ​callmestevieray & Connor Price, whose words/song- “GRATEFUL”- always lightens my load). 🎶👏🎶👏🎶

Exploring the controversial link between oral contraceptive pills and hypothyroidism, debunking misinformation and fears. Discussing the shift in common causes of hypothyroidism and a study highlighting public interest in alarming findings. Examining the controversy around birth control pills and hypothyroidism risk, critiquing methodology and findings.

New study suggests Pitocin may be better than misoprostol for labor induction after PROM, regardless of bishop score. Implications for obese patients also discussed.

Discussing the impact of maternal stress on fetal brain development and the concerning effects on the child's puberty. Exploring the positive impact of music on mood and well-being, including reducing anxiety and depression in individuals with cancer.

Exploration of using cell saver technology and erythropoietin in obstetrics for patients refusing blood products, ethical dilemmas in high-risk pregnancies, benefits of cell saver in C-sections, and ACOG guidance on reducing allogenic blood transfusion

Discussion on the use of sildenafil cream for Female Sexual Arousal Disorder, exploring the effectiveness and potential benefits of this new therapeutic option for women. Comparison with FDA-cleared Eros device, controversies around over-the-counter creams for male erectile dysfunction, and a look at medications and devices for sexual health in both men and women.

The podcast discusses the rise of hypertensive disorders of pregnancy in the US, focusing on a new study redefining medication use in the postpartum period. Updates on treatment guidelines and early interventions to prevent complications are also highlighted.

At time of post cesarean discharge, most providers prescribe a fixed number of opioid tablets. However, past data has shown that most patients don't use all the opioids they are prescribed. This leads to an excess of opioids in the community, which can ultimately lead to misuse and diversion. In this episode, we will highlight a new publication from the Green Journal (Obstet Gynecol) exemplifying an adoptable strategy using a individualized opioid prescribing protocol (IOPP). While this was published ahead of print on June 10, 2024, the concept of IOPP is not "new" at all. Listen in for details.