Dr. Chapa’s OBGYN Clinical Pearls

Exploring the potential of treating bacterial vaginosis as a strategy for preventing preterm birth, following the FDA withdrawal of a key medication. Discussing recent publications and advancements in diagnostic tools for vaginal infections, highlighting the importance of accurate diagnosis and optimized treatment strategies. Delving into the effectiveness of molecular screening tests for bacterial vaginosis in pregnant women, and the use of microbiome-based tests for enhancing diagnosis and treatment of common vaginal conditions.

FYI. We just released our episode for today, July 14, 2023, and will be out until July 23!

Its hard to be pregnancy in the late third trimester, especially in a HOT state like TEXAS in the summer. Pregnant individuals will try just about anything "to just get this baby to come out already!" Historically, walking, spicy foods, and SEX have been "employed" to get the labor process going. Does it work? In this episode we will look at the data examining whether labor can induce spontaneous labor. Is this a myth or a real thing? What about CURB WALKING?! That works, right? Lots to cover and explain in this one...so let's get our walking shoes on and get to it.

There’s no such thing as a “false positive syphilis confirmation test”, is there? After all… It’s right there in the name, CONFIRMATION test! Well, not all positive confirmation tests are true positives, especially when that test is the FTA-ABS. Yes, it’s true, the specificity for this is very good between 95 to 98%. But there are cases of BFPs (Biologic False Positives), which have been reported and published in the literature. This is why putting the test results in clinical context is very important. In this episode, we will highlight a real clinical scenario where a “low level“ confirmation test did not fit the clinical picture (asymptomatic, monogamous, low risk patient). Is there something else going on here? What about autoimmune conditions? Can pregnancy itself cause a false positive FTA-ABS? And more importantly… What are the options for management in this case? We’ll discuss all of this, and also review the “reverse syphilis algorithm” in this episode.

The Bandl Constriction Ring. It is real. It exists. Its true incidence is unclear as it lacks uniform reporting when found at time of cesarean. As labor guideline are more permissive of slowed labor progress, some fear that the incidence of Bandl's Band may rise. What is this ring? What is the pathophysiology of this abnormal uterine response? Can ultrasound detect this labor abnormality? In this episode we will cover the fascinating and controversial history of the Bandl Band and review some key publications describing its potential morbidity.

Just a little description of what happens “behind the scenes“! Enjoy. 😊😊❤️❤️😩😩

Gestational diabetes (GDM) is a risk factor for adverse perinatal outcomes. Currently, the ACOG recommends early screening for GDM for women “at risk”. However, other experts disagree with this approach. On October 6, 2022 we released a podcast episode called “Early GDM Screening: Evidence-based?”. In that episode we covered the controversy regarding early GDM screening, in other words- screening under 24 weeks. We have been following this story and debate for over 2 years now; we first released the episode investigating the utility of early screening back on May 7, 2021 with an episode called “early GDM screening: Does it matter?”. The controversy surrounds maternal and neonatal outcomes… does it improve with early screening? Well… we have more data now! YEP.. looks like we were vindicated in our prior messages covering this! In this episode, we will summarize key findings from a recent June 2023 publication in the NEJM titled, “Treatment of Gestational Diabetes Mellitus Diagnosed Early in Pregnancy”. The lead author is Simmons. So…should we be doing early screening for GDM? We’ll highlight the data.

Well, Well, Well, this is very interesting. Back in May 10, 2023, we released an episode on "OSA (Obstructive Sleep Apnea) in Pregnancy: Time to Screen?". In that episode, we summarized the impressive data on OSA in pregnancy and its association with some adverse perinatal sequelae. Spring forward to July 6, 2023, the ACOG has now released a brand new Consensus Statement on OSA in pregnancy. This statement is a joint guideline from the Society of Anesthesia and Sleep Medicine and the Society for Obstetric Anesthesia and Perinatology. Seems that we were ahead of the curve on this one. So, should we screen for OSA in pregnancy? The answer is YES and NO. Is CPAP really safe in pregnancy? We'll explain in this episode.

The headline from CNN Health form June 28, 2023 reads, "HRT use by younger women linked to dementia, study says". That is FRIGHTENING to any patient using hormone therapy for menopausal symptoms. Does HT cause dementia? Or is HT a "easy suspect"? The question of HT and cognitive function has been a subject of controversy for many years. In this episode we will summarize the NAMS position statement on HT for cognitive issues (2022) as well as summarize this new June 2023 publication from BMJ causing quite a stir among menopauses' medical experts. PLUS, we will provide a likely reason, which is the proverbial "elephant in the room", for this new study's conclusions.

First published in 1952, the Apgar Score has remained unchanged over 70 years and is entrenched in current OB/Pediatric/Neonatal care. The ACOG highlighted the Apgar Score in 2015 in CO 644. In that release, the ACOG reminds us that although it provides an accepted and convenient method for reporting the status of the newborn infant immediately after birth and the response to resuscitation if needed, it has important limitations: A. The healthy preterm infant with no evidence of asphyxia may receive a low score only because of immaturity, B. The incidence of low Apgar scores is inversely related to birth weight, and C. a low score cannot predict morbidity or mortality for any individual infant. Most importantly, it is inappropriate to use an Apgar score alone to diagnose asphyxia. It has been previously shown that not all items of the conventional Apgar score are of equal importance. However, Virginia Apgar did not differentially weigh or remove individual items since it was her intention to have a score that can be “determined easily and without interfering with the care of the infant”. Accordingly, use of the score has been found to have important use limitations across babies whose skin color has more pigmentation, leading to more NICU admissions in some despite other more objective measures of neonatal status. As the United States and many other countries have become more racially and ethnically diverse, embedding skin color scoring into basic data and decisions of health care may propagate unintentional race-based medicine. In this episode we will discuss the data leading some to call the traditional Apgar score “antiquated” and are calling for a change.