Dr. Chapa’s OBGYN Clinical Pearls

The human vaginal ecosystem is highly dynamic. The vaginal microbiome can affect host physiology, and vice versa. In 1965, Desquamative Inflammatory Vaginitis was 1st described, but the condition fell out of the spotlight. Recently, new data has brought this condition back into the light. How is this diagnosis made? Is vaginal culture recommended? That answer may surprise you. In this episode, we will review the latest information on Desquamative Inflammatory Vaginitis: its presentation, diagnosis, and treatment.

Pubic hair grooming is a highly prevalent practice with self-reported rates between 75 to 99% of women. Does this increase STI risk? In this podcast, we will review a recent September 2019 open access publication by Luster et al. There may be more to the story than what’s presented in that study. Let’s look at that...now.

Post CS endometritis is thought to be linked to ascending vaginal bacteria. In 2016, the CSOAP trial concluded that adding ZMAX to standard antibiotic prophylaxis before non-elective CS helps reduce infection. But what about vaginal prep? What’s the best solution and concentration? In this session, we will summarize a new systematic review/meta-analysis from September 2019 published in AJOG.

Mycoplasma genitalium is a facultative anaerobic organism which has been associated with cervicitis, endometritis, PID, infertility, susceptibility to HIV, and adverse birth outcomes, indicating a consistent relationship with female genital tract pathology. In 2015, the CDC listed it as an important, yet overlooked, STI. Now, a recently FDA approved test for the bacterium has increased awareness on this sexually transmitted pathogen. In this episode, we will review the microbiology, presentation, and treatment of this pathogen.

Previous evidence suggests that use of oral contraceptives, especially during adolescence, may increase women’s vulnerability to depression in the short term. On August 28, 2019, a new publication by Canadian researchers in the Journal of Child Psychology and Psychiatry restated this association. Does this prove causation? Is it time to stop prescribing birth control to adolescents? Let’s take a critical look at this new study, as well as a prior 2016 publication, plus a 2018 systematic review, and provide clinical guidelines and perspectives.

In 2014, the ACOG released a consensus statement, “Safe Prevention of the Primary Cesarean”. This extended the 2nd stage of labor by 1 hour. Was this evidence-based? New data suggest it was not, and may be harmful. In 2016, Leveno et al (Parkland Hospital) issued the first clinical commentary as a rebuttal to these changes citing lack of evidence to support the prolongation. In this session, we will review the upcoming publication (ahead of print) from Nelson, McIntire, and Leveno (Parkland Hospital) again calling these 2014 labor time-limits into question, presenting new data.

Wound healing is a complex and dynamic process! In this episode, we will review the 4 stages of wound healing using the analogy of “the broken house”. We will also describe the CDC criteria for surgical site infection (SSI) and review the 4 WHO classifications of wounds.

Air embolism during pregnancy has been reported… usually linked to blowing air into the vagina during orogenital sex. In this session, we will review the literature, presentation, and management of this uncommon- yet potentially lethal- occurrence.😳😳😳🤔

There is currently no FDA approved testosterone products for women. Internet sources, and some pharmacies, offer a variety of testosterone products for use by women. Is this evidence-based? In this session, we will review the summary statements from the US Endocrine Society and the British Menopause Society regarding testosterone supplementation in women. (US Endocrine Society Data and the British Menopause Society. Thank you, Lisa Felsman, for the podcast topic!)

Many studies have evaluated the relationship between fertility drugs and breast cancer. Are you aware of what the data shows? How would you cancel your patients? In this episode we will review the ASRM data regarding fertility medication use and breast cancer risk.