Dr. Chapa’s OBGYN Clinical Pearls

The podcast discusses the occurrence of uterine rupture in the unscarred uterus, highlighting the risk factors and emphasizing the importance of awareness. It explores the symptom of fetal heart rate changes and the increased risk associated with gynecological red flags. Risk factors for intra-partum rupture are also discussed, including prolonged labor and uterine anomalies. The podcast also explores the association between endometriosis and uterine rupture, discussing the effects on placentation and pregnancy risks.

Discover the timely alignment of clinical opinions on postpartum hypertension and the role of magnesium sulfate in care. Insights reveal the importance of personalized strategies in treatment amid ongoing research gaps. Explore the uncommon occurrences of eclampsia beyond a week postpartum, alongside the speaker’s reflections on empathy in healthcare and the vital support of family. It's a fresh perspective that emphasizes both clinical knowledge and human connection in managing severe postpartum conditions.

Data has shown that more than half of maternal deaths occur past the traditional 6 week postpartum mark. This is why the ACOG recognized the “fourth trimester” in 2018 (ACOG CO 736), reflecting the fact that the patient is still at risk beyond the first 6 weeks after delivery. One of the main areas of focus postpartum is on hypertension care. Growing understanding of the long-term implications of HDP and other medical complications of pregnancy have led to an increasing focus on building transitions from postpartum care to primary care, which will be essential for the long-term wellbeing of women with postpartum hypertension. How many women will develop new onset hypertension more than 6 weeks from delivery? At what blood pressure cut off should anti-hypertensive medication be considered postpartum? Should it be at 150/100 or 140/90? Which medication is preferred for postpartum use? Is magnesium sulfate for severe range blood pressures effective as seizure prevention beyond 7 days postpartum? We will tackle these questions, and more, in this episode.

This podcast discusses the lack of updates in A-Cog's practice bulletin on asthma in pregnancy and introduces new recommendations from Gina. It covers topics such as the impact of asthma on fetal growth and maternal quality of life, the use of biologics in pregnancy, and the importance of inhaled corticosteroids in treating asthma.

It’s a universal nomenclature… The TPAL system. Despite its traditional and long-standing integration into obstetrical vernacular, there are significant gaps in this system. And, although we use these terms daily, there is controversy about what one of those elements actually means. What is the “L“ actually for? We’ve all learned it as “living children”. But what does that actually mean? Is that live births? Is it number of living children at time of the report? Or does it mean something entirely different? In this episode, Dr. Katie Light joins me as we have a fun time looking into the data. Hang out with us until the end of the episode, because I will give us some practical insights for using the TPAL nomenclature.

This episode is our NEWS BRIEF. Yesterday, on November 15, 2023, the FDA approved the first, patient self-collected, home test kits for GC and Chlamydia. This is a BIG advancement for women's health. But, this is actually not the first at home STI test to be approved. In this episode, we will review this new FDA approved test, the specifics of the product, and why this is not just a "direct to consumer" purchase item.

Recently, we released an episode regarding the limited utility of by BMEs; now, I mean, limited utility as a routine, annual exercise in the low-risk asymptomatic, and non-pregnant patient. And there’s plenty of evidence that has shown that just doing a bimanual exam because “that’s what we’ve always done” -without a real indication- is just not helpful. All to say, we received numerous comments regarding that episode with 99% saying, “this is great”, “thank you for sticking with the evidence”, and “yes, we stopped doing bimanual exams without indication, when the ACOG first put that out several years back”. But of course there’s always that 1% who state something like, “I can’t believe you’re not recommending this exam, this is how we find ovarian cancer, etc”. This is very interesting because the whole episode was how it exactly did NOT help in the early detection of ovarian cancer, but simply increased the ordering of tests and patient anxiety! (Which makes me think, maybe they didn’t even listen to the episode). One of the comments that came in was worth noting. This provider said, “Isn’t the same debate applicable to clinical breast examinations (CBEs)?” What’s the data on that? And how do various medical groups and professional societies agree or disagree with CBEs? Well, that’s exactly why we’re doing this episode! In this episode, we’re going to cover the various guidelines and opinions regarding the utility of clinical breast examinations. Plus, you’ll want to hang out with us until the end of the episode, when we will provide some real, practical applications for daily practice. Yep, let’s “feel the data out” (see what I did there?). 🧐🙂🙂

Trichomoniasis, a prevalent STI, is associated with adverse outcomes in pregnant women. The podcast explores the controversy of treating asymptomatic trichomoniasis in pregnant patients due to conflicting studies. The hosts support treating all pregnant patients to reduce risks and adverse outcomes.

The pelvic examination is a standard component of the annual gynecologic visit despite limited evidence supporting its utility. Pelvic examinations can be a source of discomfort and anxiety for some patients seeking routine health care, whereas, for others, they can offer reassurance. In 2018, the ACOG released CO 754 on "The Utility of and Indications for Routine Pelvic Examination". What does the AAFP, ACP, and ACOG say about "routine" pelvic examinations in low-risk, nonpregnant, and asymptomatic women? Why do they say what they do? In this episode, we will summarize a new publication from Obstetrics & Gynecology which was just released yesterday (November 9, 2023) which validates these professional societies' guidelines/stances.

What do think about when I mention to you, Placenta Accreta Spectrum (PAS)? You would probably think placenta previa and prior C-section, right? You should! Those are the two most well-known risk factors. But placenta accrete can happen without either of those 2 factors, although less commonly. I was recently asked to provide insights on a real case of suspected PAS in a primiparous patient who was suspected of having placenta accrete at attempted placenta extraction at time of her primary C-Section performed for failure to progress. Her placenta was fundal. Can a fundal placenta be an accreta? What is the frequency of that? And what is the expected patient morbidity? We’ll examine the data and highlight a recently published case report from September 2023 describing a similar presentation.