Dr. Chapa’s Clinical Pearls.

Postpartum neuropathies are an infrequent occurrence but can significantly impact a patient's quality of life. Are you familiar with “strawberry picker's” neuropathy? It is the most common type of nerve injury during vaginal delivery. In the session, we will review safe maternal positioning during vaginal delivery.

New onset hypertension in the postpartum period should be assumed to be preeclampsia until proven otherwise. Up to 26% of eclamptic seizures occur beyond 48 hours and as late as 4-6 weeks after delivery. However, most of eclamptic seizures occur within the first 7 days after birth. In this session, we will review the recently updated CMQCC healthcare provider toolkit focusing on delayed postpartum hypertension/eclampsia. We will also point out a frequently forgotten fact about a potential risk of methyldopa use in the postpartum interval.

Thanksgiving 2021 is upon us! However, did you know that mental health experts make the very important distinction between gratefulness, thankfulness, and gratitude? While being thankful is important, it is much more vital to live in a state of Gratitude. In this session, I am joined by Lisa Chapa (LCSW). We will explore this concept and the Science of Gratitude.

(Introducing Dr. Garrett Dunn as guest resident on today's episode!) The CDC estimates that more than 1.1 million people in the US are living with HIV infection, and 1 of 7 individuals is unaware of their infection. HIV care has come a long way over the years. In this episode, we will review QUICK FACTS from the SMFM on HIV care during pregnancy. Data summarized is from the last SMFM update on HIV care in pregnancy (Checklist data).

How do you diagnose vaginitis? Do you treat BV/yeast/trichomoniasis found on Pap smear? Do you use the Wet Prep, or molecular/DNA test? An ePub recently released in Obstetrics and Gynecology (the Green Journal), revealed some disappointing results for the Wet Prep. In the session, we will summarize key points from this article, as well as remind all of us of some key information released by the ACOG in January 2020 regarding vaginitis in the non-pregnant patient.

This session is a follow-up to our immediate pest episode. Are there any evidence-based true alternatives to the 50 g screening test for GDM? What about hemoglobin A-1 C? What about home blood glucose monitoring? Let's dive into the data and see. We will also introduce you to… “Chapa chocolates”.

It's true, patients do NOT enjoy the 50 gram oral glucola test for gestational diabetes screening. And, the 100 gram test is even worse! Online sources claim that consuming a certain number of jellybeans is comparable to the standard screening/diagnostic test. Is that valid information? In this session we will review this jellybean theory and review what the data actually says.

The prevalence of Hepatitis C viral infection in pregnancy has doubled over the past 10 years. Active hepatitis C viral infection in pregnancy increases the risk for both maternal and neonatal morbidity. In the session, we will review this alarming trend along with key screening and management recommendations from the ACOG/CDC/SMFM.

In this episode, a simple to follow algorithm for management of APS in pregnancy will be presented. We will cover both antepartum and postpartum care.

Antiphospholipid syndrome has well established diagnostic criteria. Nonetheless, healthcare providers still find the condition- and it's management-somewhat confusing. In this session, we will cover the diagnostic criteria for APS and who qualifies for investigation. In Part 2, we will cover specific management algorithms in pregnancy.

Fetal renal pelvic dilation occurs in 1% to 5% of all pregnancies. Although most are benign, it can be associated with genetic and structural disorders. Are you familiar with the CAKUT syndrome? When should Chromosomal MicroArray Analysis (CMA) be offered? What about prognosis? In the session, we will summarize and highlight the main points of the SMFM consult series #4 covering fetal renal pelvis dilation.

Just a quick message response for one of our listeners, Liane. Great points Liane… I take your message to heart! Here's is our response. Thank you for being a contributing part of our listening family.

October is Domestic Violence Awareness month. This is such an important issue to discuss, and we will give into it here! Making her podcast debut is one of our residents, Dr. Katie Light. AND… as you will learn at the end of the podcast, she's also a very proud Texas A&M Aggie! WHOOP.

Molnupiravir is now on the scene as a potential new therapy for mild to moderate COVID-19. As an oral administered medication, this could revolutionize care of the condition. In this session, we will review the early origins of this medication, its MOA, and what the data in the phase 3 study showed.

There continues to be a lot of faulty assumptions regarding testosterone therapy in women. In 2014 the Endocrine Society joined an international panel and provided an evidence-based review of testosterone use in women. This was reaffirmed in 2017 and 2019. Most recently, in October 2021, the ACOG released a “clinical commentary” ahead of print, “Testosterone Therapy in Women”. In the session, we will review this soon to be released current commentary and provide key clinical pearls regarding the use of testosterone replacement in women.

Sexual climax has been defined not only as a bodily/physiological reaction but as a mental process as well. First termed “the little death” historically, the phrase focused on the altered state of awareness following sexual release. But there's many reasons/benefits why sexual release may be voluntarily delayed (by mutual agreement) during intimacy. In the session, we will approach the once taboo subject which has now gone mainstream. So let's talk about “the edging experience” and what medical evidence there is to support it.

Thank you to Dr. Leslie Clark (Senior Resident) for your great work in wrapping up our discussion on antepartum fetal surveillance. In this session, we cover one of the most misunderstood tests in fetal surveillance, the biophysical profile. Is the NPV for the modified version the same as the full? Which test is the “most reassuring”? We will answer this question and more in the session!

In this session I am joined by one of our upper level (Senior) wonderful residents, Dr. Catherine Jimenez. Dr. Jimenez and I recorded this as an impromptu podcast covering antepartum fetal surveillance. Does maternal eating actually affect fetal movement? Do kick counts really work to prevent fetal morbidity? We will cover these questions, and more, in this episode (Part 1).

Here's a question for you: would you rather have motivation, or inspiration? Used interchangeably in common dialogue, the two can actually be polar opposites. This is a brief review of the power of inspiration, not just in our daily work, but in living life overall. Taken from psychological studies and CBT, this session will hopefully INSPIRE you in your daily life. Choose inspiration over motivation!

PTSD has come a long way from its original designation as “shellshock”relating to veterans of war. PTSD is also possible following childbirth, even in otherwise “uncomplicated” Labor And Delivery events. Childbirth-related PTSD has been historically overlooked. In this session we will summarize the DSM5 criteria for this condition in order to better recognize and diagnose the condition.

In this session we wrap up our discussion of emergency contraception. Is there a preferred option for those with larger BMIs? What if the patient has emesis after a dose of oral EC? We will summarize the evidence/data here.

Despite its use for decades, misinformation and misperceptions about emergency contraception still persist. Are all options the same? What is their efficacy? Does bodyweight affect EC's ability to prevent pregnancy? And what about medical contraindications to birth control use? In the session, which is Part 1, we will dive into the facts regarding emergency contraception.

The US is ranked 65th among industrialized nations for maternal morbidity and mortality outcomes. That is unacceptable! Maternal levels of care initially began in Texas. Now, there is a plan to make this nationwide. With the goal of reducing maternal mortality and morbidity in the United States, ACOG has partnered with The Joint Commission on the development of a new Maternal Levels of Care (MLC) Verification program, effective January 1, 2022. This session, we will review what this program will look like as well as its primary goal.

Available mAbs are directed against a large number of antigens and used for the treatment of immunologic diseases, reversal of drug effects, and cancer therapy. Now of course they are also being used against COVID-19. As these are IgG based, is the use of monoclonal antibodies allowed in pregnancy? What is the ACOG/SMFM position statement? In this session, we will review the latest data regarding monoclonal antibody use in the OB patient.

Tranexamic Acid's use in obstetrics skyrocketed in 2017 after the release of the WOMEN trial. At that time, the ACOG endorsed TXA for use with diagnosed PPH, not for its prevention. Does TXA prophylaxis reduce postpartum hemorrhage? Does it matter whether it is used at vaginal birth or cesarean? Data moves fast and we will highlight those new answers here.

(Part 2) In this session, we will wrap up our summary review of the ACOG September 2021 Clinical Consensus bulletin on postpartum pain management. What are “ultra rapid metabolizers” of opioid medication? How does that affect our prescriptions for postpartum pain control? In this session we will answer these questions and more! ⚕️⚕️⚕️⚕️

Uncontrolled postpartum pain can lead to postpartum depression, impaired maternal-child bonding, and even chronic pain syndromes. Uncontrolled postpartum pain can also lead, in some individuals, to a form of PTSD. In this session, we will review the September 2021 Clinical Consensus statement from the ACOG on using a “MultiModal Stepwise Approach” to Postpartum pain management. Do NSAIDS increase blood pressure? When are TAP blocks recommended? We will answer these questions and more in this session. (This is Part 1)

The diagnostic algorithm for primary amenorrhea is extremely logical once one understands this pathophysiology. While some patients presenting with primary amenorrhea are indeed genetic females, some are actually 46XY. Do you remember the difference between Swyer syndrome and androgen insensitivity (AIS)? In this session, we will present an easy to follow diagnostic algorithm for primary amenorrhea based on ASRM guidelines. We will also provide high-yield facts contrasting Swyer syndrome with AIS.

At the end of July 2021, the CDC updated its treatment guidelines for sexually transmitted infections. Changes were made to recommended treatments for chlamydia, gonorrhea, trichomoniasis, and PID. There's also new updated information regarding mycoplasma genitalium. In this session, we will provide a summary review of the key take-home changes made by the CDC.

In this episode will conclude our discussion of primary dysmenorrhea. We will focus on non-hormonal and non-pharmacological alternatives for management of primary dysmenorrhea (Part 2; ABOG MOC).

Our understanding and management options for primary dysmenorrhea have evolved over the years. In this session, we will review the pathophysiology of primary dysmenorrhea and summarize the first-line treatment options for the condition. The information for this podcast comes from the ABOG MOC reading list for 2021.

In 2003, the ACOG/SMFM endorsed IM progesterone for PTB prevention. But new data has called this into question (PROLONG trial). In this session, we will review the PROLONG data and compare it to the newly released EPPPIC study. What does the ACOG now recommend? We will answer these questions and more in this session.

The last time ACOG released a practice bulletin on the prevention of preterm birth was in 2012. In August 2021, the ACOG will release a new practice bulletin addressing prediction and prevention of preterm birth. In this session, we will summarize transvaginal ultrasound for cervical length screening. Is there a “reassuring“ cervical length using TRANSABDOMINAL ultrasound? When should these be done? And what about all the new progesterone data? Listen to find out.

Non-sexually acquired genital ulceration (NSGU) is painful ulceration of the external genitalia, usually in adolescents, unrelated to sexual activity. In this session, we will review the likely ideology, the clinical presentation, its diagnostic criteria, and the management approach for this condition.

There is a whirlwind of false/misleading information on social media regarding the COVID-19 vaccines. Some social media posts state that breast-feeding should be STOPPED after this vaccine. Is that evidence-based? What does the Academy of Breast-Feeding Medicine recommend? In this session, we will review a recent report from JAMA Pediatrics (July 2021) which provides some much needed clarification on breast-feeding after COVID-19 (mRNA) vaccination.

Our understanding of Intrahepatic Cholestasis of Pregnancy has changed just over the last 5 years. What is the best laboratory test to help diagnose this condition? At what level of total serum bile acids is the risk of fetal death greatest? What does the SMFM say about induction of labor for these patients? In this episode, we will highlight and summarize the latest clinical brief on ICP from the SMFM (2021). This is SMFM consult series # 53.

In this session, we will wrap up our summary review of the ABOG MOC article. What is the most predictive ultrasound marker for torsion? Are most affected organs anterior, posterior, or lateral of the uterus? Let's find out these answers and more!

Adnexal torsion can present in women of all ages but is most likely to occur during the reproductive years. Is removal of a torsed adnexa considered first line? What side is ovarian torsion most likely to occur? In this session, which is Part 1, we will begin our summary of the ABOG MOC (2021) Gynecology article by Moro et al.

Thank you for sharing your message! And, most importantly, congratulations on your board certification! Hope this makes someone else smile, as it did for me.

Atypical Breast Hyperplasia may present either as Atypical Ductal Hyperplasia or Atypical Lobular Hyperplasia. Which of these two is considered the more “pre-malignant”? Is surgical excision necessary for all atypical breast hyperplasia? Who qualifies for tamoxifen? And, how does breast tomosynthesis fit into the management scheme? We will dive into these questions and more in this session.

Correction of iron deficiency anemia in pregnancy is not just about fixing a low “H & H”. Iron deficiency during pregnancy is associated with real adverse maternal and neonatal outcomes. What is the best way to take oral iron supplementation? What about IV iron? Does “intramuscular” iron injection have a place in practice? Let's cover these questions and more in this session.

Nifedipine is one of the most common medications used for tocolysis. However, does it actually improve neonatal outcomes? What about tocolysis in general? In this session we will review a new randomized trial from Parkland, published in July 2021 in Obstetrics Gynecology (Green Journal).

According to the latest US Census Bureau report analyzing the use of languages in the United States, over 20% of Americans speak a language other than English at home. Of this population, greater than 24% report that they do not speak English well or do not speak English at all. With a US population of more than 300 million, this makes over 70 million people with limited English proficiency. In this session, we will review best practices for using medical translation with our patients and why using family members as “ad hoc translators“ can land us in hot water (aqua caliente!)

Our understanding of gestational diabetes has changed over the last two decades, and more changes are sure to come! The traditional screen between 24 to 28 weeks may actually be too late. Enter the “GO MOMs” study. This NIH study, starting now, aims to answer the persistent unknowns regarding maternal blood levels during gestation. Listen to how this remarkable study may impact our screening, diagnosis, and management of gestational diabetes in the very near future.

Welcome back! In this session, we will review the contraindications for LEEP and the specific indications for CKC.

In 2019, the ASCCP made some impactful changes to the management algorithm for cervical dysplasia. Why was the treatment algorithm divided between those under the age of 25 years and those over 25 years of age? When is observation without excision preferred? And, what's the best way to perform surveillance after an excision procedure? In this session, which is Part 1, we will review the guidelines related to surgical excision of high-grade dysplasia.

Cesarean section is the most common laparotomy performed worldwide. So, you would think we would have a standardized way of closing the uterine incision. But we don't! What does the data say about single layer hysterotomy closure compared to two layer closure? Is one really better for TOLAC? Is one associated with more complications than the other? The answer is a little bit more complicated than you think. In this session, we will review the aggregate data on this persistent debate.

I love how our medical community can come together to discuss and brainstorm on better ways to care for our patients. Last night I received a message from Allison, from Chicago. Thanks Allison! She had a question regarding our recent RLS podcast and the potential role for magnesium supplementation for the condition. Is magnesium an effective treatment choice for RLS? Let's review that data now.

Welcome to Part 2! In this session we will complete our discussion of RLS in Pregnancy and review its workup and management strategies.

Restless Leg Syndrome (RLS), now often referred to as Willis–Ekbom Disease (WED), is a common sensorimotor disturbance much more prevalent in women and during pregnancy. Do you know the potential pathophysiological tie between pregnancy and this condition? What are RLS symptoms? What about treatment? Let's dive into this very common, yet largely overlooked, issue in the session.

The FDA has approved Brexafemme, an antifungal drug, for treating vaginal yeast infections. The drug represents the first new antifungal drug class in 20 years. How does this new medication work? and What's the dose? Does this work for recurrent vaginal cases? Please note that there are also some cautionary items that WE MUST address here... Lets cover that now!