Dr. Chapa’s OBGYN Clinical Pearls

According to the ACOG, by natural menopause it is estimated that up to 70% of women will have developed a uterine leiomyoma. 70%! Most of course are asymptomatic. For those with symptoms, heavy menstrual bleeding and pain are the most common afflictions. In May 2021, the FDA approved a new triple combination pill for heavy menstrual bleeding associated with fibroids. Can this medication also be used as hormonal birth control? We will review the ACOG, FDA, and manufacture’s information for MyFimbree in this clinical update.

Meet Hilda! In this quick episode, I’ll share a very unique story of one of our coworkers (our featured guest on the podcast). I know this will encourage, inspire, and just make your day! Listen in, and find out why.

There are currently (in the USA) 4 generations of available progestins in combination birth control pills. Are these differences clinically relevant, or is it all manufacturer marketing? In this session we will review the chemical nature, biology of, and clinical manifestations of the different progestins. We will set the record straight. (This topic was suggested by an OB/GYN senior resident at Lincoln Hospital, South Bronx… Thank you for listening to our podcast and for the wonderful podcast topic suggestion).

Fetal microcephaly is a devastating diagnosis. Prognosis is dependent on whether fetal microcephaly is isolated or part of other congenital anomalies. Prognosis is also directly related to the degree of fetal microcephaly. In this session, we will review the diagnostic criteria, workup, and prognosis of this devastating fetal condition.

Here’s what’s going on… As of May 26, 2022.

Pregnancy can definitely work some changes on the body. Melasma is a common pregnancy reaction, and can be a cosmetic concern to many affected. Are treatments safe to use during pregnancy? Are cutaneous lasers allowed? In this session we will review the available literature and cover the first, second, and third-line options for treatment of the mask of pregnancy.

The etonogestrel implant is the most effective LARC available. Well, how many years AFTER the FDA approval of 3 years does the implant remain effective? Also, currently, the usual and customary standard is for the provider and patient to palpate the implant area after insertion. But what happens when the insert is non-palpable? In the session, we will review the evidence-based protocol to find this nonpalpable implant. Can you order a serum etonogestrel level? Do these things “migrate”? Can a patient still use it for birth control after 3 years? Listen in, and find out.

Historically, obstetrical providers cautioned patients about decreased fetal movement. But what about maternal perception of INCREASED fetal movement? Is increased fetal movement a harbinger of adverse neonatal outcome? In this session we will highlight and summarize a new publication from the AJOG (April 26, 2022) that helps shed light on this clinical conundrum.

Since the 1960s, metronidazole has carried a label warning stating that alcohol use while taking the medication can lead to significant side-effects. This was termed a “Disulfurim-like reaction”. However, that’s 100% not true! Where did this metronadazole myth come from? Why has it survived for over 50 years? In this podcast… We’ll set the record straight! Yes, you can have your cake and eat it too… I mean, your beer and drink it too! 🍻🍺🍻🍺🍷🍷🍷

On May 3, 2022, JAMA published 2 separate randomized clinical trials (RCTs) regarding patient’s self-monitoring of blood pressures at home. Historically, clinicians instructed patients either at risk of developing hypertension in pregnancy or those with existing chronic hypertension/hypertensive disorders in pregnancy to self-monitor their blood pressure in-between clinician visits. Is that recommendation clinically useful? Does the data support that? Once again, the world of “hypertension in pregnancy” is being shaken up! In this podcast we will review these 2 recent RCT studies which may the change the way we practice obstetrics.