Dr. Chapa’s OBGYN Clinical Pearls

I recently had a patient (young reproductive age, without prolapse or urinary incontinence) ask me about using the “Jade Egg” vaginally for better sex. Women’s sexual intimacy is a big dollar commercial industry. What’s the history behind this Jade Egg and/or other vaginal insertion weights? Is there a benefit to using these inside the vagina for pelvic floor training and enhanced sexual intimacy? Are these any better than regular Kegel exercises? In this episode, we’ll do a deep-dive into the data and find out when, if ever, these devices may be used as ancillary tools.

Exploring the validity of using meconium staining as a marker for hypoxia during childbirth, examining its use in medico-legal cases and the possibility of estimating the interval from meconium passage to birth. Discussing studies on the relationship between meconium staining and duration of exposure, highlighting methodological flaws and complex contributing factors. Exploring the concept of meconium staining, potential complications, prevailing theories on its passage, and controversies surrounding its correlation with fetal hypoxia.

Oh, the ever evolving drama of “progesterone in high risk obstetrics”. Today, April 13, 2023, the SMFM released its Special Statement response to the recent change in the progesterone PTB prevention landscape. Where does cerclage fit in? In this episode we will summarize the current recommendation for cerclage for preterm birth prevention and how it fits in to the vaginal progesterone story. Is cervical ultrasound surveillance after vaginal progesterone initiation warranted? We will make it clear in this episode.

We have come a long way in our understanding regarding the safety of intrauterine contraception. Once withheld from adolescents and immediately postpartum patients, the safety in both populations is now well established. Postpartum IUD/IUS placement is a balance between risk of expulsion and patient loss to follow up. In this episode, we will summarize a new RCT from JAMA discussing this very subject. Is it better to place immediately Postpartum, at 2 weeks after delivery, or as an interval procedure at 6 to 8 weeks? We will summarize this Level I evidence and also provide helpful resources for increased accessibility of LARC options, including the new (April 2023) ACOG Committee Statement on this very issue.

This episode is in reply to one of our fantastic podcast family members who had some wonderful clinical questions regarding dosage of combination BC after listening to our past episode. In our immediate past episode, we discussed hypoestrogenemic symptoms on ultra low-dose pills in certain patients (young, thin). Is a 20 µg BC pill less thrombotic than a 30 or 35 µg pill? What does the data say? In this episode will answer this question and also dive deeper into serum estradiol levels not only with combination birth control but also with menopausal hormone therapy. Is there a “target level” of systemic/serum estrogen with combination HRT? Listen in and find out.

In 1972, a publication in which a radioimmunoassay measured serum estradiol levels in participants taking oral combination birth control concluded that levels of serum estrogen were “sufficient to prevent symptoms of estrogen deficiency”. Knowing NOW what we do, and looking back to that article, those authors’ conclusions were completely incorrect! Is it possible for a patient to experience hypoestrogenic symptoms despite taking an estrogen containing birth-control? What are normal, endogenous estradiol levels in a reproductive age female? In this episode, we will review the various degrees of hypothalamic – pituitary – ovarian axis suppression from different categories of hormonal birth-control. Should certain micrograms of ethinylestradiol be preferred in thin and/or adolescent patients? Listen in and find out.

Here’s proof that our catchphrase, “Medicine Moves Fast“ is 100% true! On October 30, 2022, and again on November 1, 2022, we released episodes on “Dense Breasts on MMG? What to do?”. Those episodes were in response to Katie Couric’s public outcry for the need for additional screening at time of mammogram in the setting of dense breasts. On March 9, 2023, the FDA issued a new ruling/guidance on patient notification of breast density at screening mammogram. And now, in April 2023, the ACOG has released its new Practice Advisory (PA) on the subject. In this episode, we will quickly summarize this practice advisory, it’s implications for us as clinicians, and implications to our patients.

A quick update and commentary on the recent (April 6, 2023) FDA decision to withdraw approval of Makena for preterm birth prophylaxis.

Pregnancy causes some well-known and well documented physical changes to the body. While hyperpigmentation, breast enlargement, and increase in vaginal discharge are non-disputed physical changes during pregnancy, other effects on mental capacity (memory and cognition) are more controversial. Does “mommy brain” really exist? Or is it a fulfilled psycho-social expectation? Does pregnancy actually change the brain? In this episode, we’ll present the data and provide some practical tips at the end of the show to help tackle the elusive foe called “momnesia”.

For a patient who presents after an episode of unprotected sexual intercourse, seeking testing for STIs, it’s important to know when to perform the test. The time between infection and a positive test is called the testing window. This testing window can be different for different pathogens. In this episode, we will review the importance of knowing this testing window, and we will also review the differences between pathogen inoculation, incubation/latency, and their overlap with the testing window.