Dr. Chapa’s Clinical Pearls.

Anchor FM

Relevant, evidence based, and practical information for medical students, residents, and practicing healthcare providers regarding all things women’s healthcare! This podcast is intended to be clinically relevant, engaging, and FUN, because medical education should NOT be boring! Welcome...to Clinical Pearls.

Location:

United States

Networks:

Anchor FM

Description:

Relevant, evidence based, and practical information for medical students, residents, and practicing healthcare providers regarding all things women’s healthcare! This podcast is intended to be clinically relevant, engaging, and FUN, because medical education should NOT be boring! Welcome...to Clinical Pearls.

Language:

English


Episodes

Pregnancy at Age 35+ (ABOG MOC review)

2/9/2023
According to the CDC, there has been a continued upward trend in the mean age of pregnant women in the US. This is also being seen globally. Women, age 35 years and older are at higher risk for adverse pregnancy outcomes. Are growth ultrasounds recommended in the third trimester in this population? Are congenital anomalies more frequent? And at what age is antepartum surveillance recommended? In this episode, we will review the ACOG Obstetric Care Consensus # 11 from August 2022, which is...

Duration:00:21:05

TVUS ES in AA Women (ABOG MOC Review)

2/6/2023
Endometrial cancer is the fourth most common cancer in the US and is increasing in incidence each year. Heartbreakingly, despite postmenopausal bleeding presenting as the main symptom in all patients with endometrial cancer, there is a large racial disparity in endometrial cancer mortality in African-American women compared to White women. The 2 largest factors contributing to this are advanced stage of diagnosis and histological cancer type. In this episode, we will review the ABOG MOC...

Duration:00:23:09

Obesity in Pregnancy (ABOG MOC Review)

2/4/2023
Obesity is the most common health problem in women of reproductive age. Over the last 2 decades, the rates of obesity have increased resulting in a range of complications in pregnancy and in overall health. Does obesity in pregnancy contribute to preterm birth? What about congenital anomalies? Are obese women more likely or less likely to breastfeed? In this episode, we will review the publication from the New England Journal of Medicine (July 2022) reviewing that data on the subject, which...

Duration:00:26:22

Winning Against Placenta Accreta Spectrum

2/1/2023
The first case of placenta accreta listed on PubMed was reported in 1927 by Dr D.S. Forster out of Montreal. That was 1 case in 8000 deliveries! Now, according to the National Accreta Foundation, PAS occurs in 1 in 272 pregnancies. How did we get to this rate? In this episode we will highlight data from ACOG, SMFM, and the National Accreta Foundation. We will highlight key ultrasound markers, patient risk stratification, and review what a PAS Care Center is. This is how we win the battle...

Duration:00:27:15

Non-vigorous Baby & Umbilical Cord Milking: New Feb 2023 Data

1/29/2023
Delayed cord clamping (DCC) provides vital placental transfusion to newborns and is endorsed by ACOG, SMFM, March of Dimes, and the ACNM. However, DCC in nonvigorous newborns may not be provided owing to a perceived need for immediate resuscitation. Umbilical cord milking, in late-term and full-term neonates, is an alternative in these cases. In December 2020, the ACOG’s Committee Opinion stated a lack of outcomes data for umbilical cord milking in nonvigorous newborns. This Level 1 data has...

Duration:00:14:44

IUD Use After Ectopic?

1/27/2023
Historically, IUDs where considered contraindicated in a patient with a prior ectopic pregnancy. This was due to concerns that IUDs may be causative of tubal gestations. Is this true? Are IUDs contraindicated with a past history of ectopic pregnancy? In this episode we will review the data from the CHOICE project, the CDC (US), and the Royal College of OBGYN (UK). We will also summarize key findings from a May 2022 Green Journal publication that investigated this very issue, and we will...

Duration:00:18:55

Epidurals=Autism? New 2023 Data.

1/25/2023
A 2020 publication from JAMA Pediatrics reported that labor epidural analgesia may be associated with an up to 37% increased risk of offspring autism spectrum disorder. The ASA has rejected those results based on methodologic limitations of the study, the lack of biological plausibility. But some remain fearful of labor epidurals because of that publication. In February 2023, a new publication in AJOG will help put this matter to rest with the largest population-based analysis done to date....

Duration:00:12:14

PRP Ovarian “Rejuvenation”

1/22/2023
Platelet Rich Plasma (PRP) therapy is a HOT and TRENDY item right now. PRP use was initiated in sports medicine in the 1970s. It has since expanded into many medical specialty fields, and now it is being heralded as the new hope for diminished ovarian reserve for those desiring pregnancy…even in menopause! Can injecting the ovaries with PRP really rejuvenate the ovary? We’ll examine the evidence as it sits as of January 2023.

Duration:00:24:23

Routine OB Urine Dips per Visits?

1/19/2023
Routine, repetitive urine dipsticks (meaning at each prenatal visit) were introduced into prenatal care back in the 1960s and 70s. The idea was to act as an early screen for bacteriuria (ASB), proteinuria as a screen for preeclampsia, and glycosuria as a screen for GDM. That was based more on expert opinion rather than clinical trials. The utility of urine dipstick testing in pregnant women has been debated for years, with studies suggesting minimal use in asymptomatic patients. Urine dips...

Duration:00:17:45

IUDs Don’t Cause Abortion

1/17/2023
Paragard, Mirena, and Liletta IUDs are the most effective types of emergency contraception. Data from the 1980s, now seemingly forgotten, showed that IUDs work primarily on inhibition of fertilization rather than implantation effects. Nonetheless, misperceptions regarding the IUDs mechanisms of action persist, with some websites stating IUDs are abortive agents. Do IUDs cause abortion? Let’s examine the evidence.

Duration:00:22:15

The Placenta Menu? Placentophagy Reviewed.

1/15/2023
“Placentophagy” is not a new concept. Most non-human mammals eat their placentas after giving birth but humans, historically, have not. Is there evidence to support this practice? Where did this idea come from? How did Rolling Stone magazine help launch this phenomenon back in the 1970s? Is Kim Kardashian onto something cutting edge by advocating for Placental encapsulation? In this episode we will walk through history and learn some pretty remarkable things about this practice. Grab your...

Duration:00:21:25

Max Pitocin Infusion Rate (mU/min)?

1/12/2023
The American College of Obstetricians and Gynecologists supports the use of both low-dose and high-dose oxytocin regimens to induce and augment labor, but does not specify MAXIMUM DOSE RATES. Most hospitals, however, have protocols that impose a maximum dose rate of oxytocin infusion. Is this evidence-based? Is there a danger with going above a certain threshold of infusion, for example, greater than 20 milliunits/minute? A new publication coming out in Obstetrics and Gynecology (the Green...

Duration:00:22:02

Don’t Do Surveillance For These!

1/10/2023
The ACOG states, “In spite of its unproven value, antepartum fetal surveillance is widely integrated into clinical practice in the developed world”. Antepartum fetal surveillance can be done by a variety of techniques and, despite its unproven value, is a mainstay of obstetrical management. At what BMI should we offer fetal surveillance? Is this current BMI or pre-pregnancy BMI? And what about advanced maternal age? What is recommended for that? Did you know that there was a change in the...

Duration:00:18:46

Breech! ECV and Beyond

1/8/2023
Breech presentation at term occurs in approximately 3 to 4% of pregnancies. While the vast majority are simply chance events, breech presentation could be a marker of other fetal comorbid conditions. When should ECV be attempted? Does the ACOG recognize neuraxial analgesia as a tool to increase ECV success rates? What’s better spinal or epidural block? What are relative contraindications to ECV? In this episode, we will summarize the latest data on fetal breech presentations and answer key...

Duration:00:33:52

Folic Acid, Folate, or L-Methylfolate?

1/4/2023
On some current social media channels, there is a hot debate as to why professional medical societies still recommend prenatal folic acid compared to the more “biologically, active” L-methylfolate. Are they onto something here? Published data has shown that anywhere from 40-60% of the general population may have an MTHFR mutation leading to the inability to process folic acid. Should we be screening for this mutation? What about screening for homocystine levels? Are these medical societies...

Duration:00:24:52

Don’t Forget Prenatal Choline!

1/2/2023
Currently on social media, there seems to be an interest in prenatal choline supplementation. Choline, a B vitamin, is not typically within standard prenatal vitamins. Is this micronutrient important for prenatal supplementation? What do professional/medical societies have to say regarding prenatal supplementation? What’s the data? In this episode, we will summarize choline’s role in fetal/newborn development, examine the data regarding deficiency, and talk supplementation recommendations....

Duration:00:30:28

Fibroids, Menopause, and HRT

12/28/2022
Uterine fibroids are benign tumors that arise from a single genetically altered myometrial stem cell under the influence of gonadal hormones. Traditionally, it has been taught that fibroids universally diminish in size after menopause. However, an article published in 2021 showed a possibility of fibroid growth after menopause in overweight/obese women. Do fibroids need surveillance in menopause? Is HRT contraindicated in the fibroid patient? And which HRT is the most fibroid friendly? We...

Duration:00:25:51

A Life Lesson From “ER”

12/27/2022
I am a fan of the original hit TV show, “ER”. Although mostly melodramatic and outside of bounds of reality Medicine, one episode (season 6, episode 6) has a valuable life lesson for all of us. I originally viewed that episode when it was live and current, and I have never forgotten the message. In this episode, will discuss this important life lesson learned, and I promise you won’t be the same thereafter.

Duration:00:14:16

TikTok’s #IUD is Killing a GOOD LARC!

12/23/2022
In January 2023, a new publication in Obstetrics and Gynecology- the Green Journal, will highlight the disheartening statements being made on social media (TikTok) regarding IUDs. IUDs are highly effective forms of contraception and the progesterone releasing variety have significant non-contraceptive benefits. Most of the dissatisfaction stated on social media surrounds pain during insertion. Do you offer topical lidocaine for IUD insertion? Ever consider lavender aromatherapy? What about...

Duration:00:28:29

Vag Prep at CS UPDATE

12/20/2022
Pre-operative vaginal preparation before gynecological surgery has unquestionable benefit for the prevention of postop infectious morbidity. Does the same hold true for vaginal prep at C-section? There has been over a decade of data, but a new publication- soon to be released in AJOG- is calling previous results into question. Does iodine work as a vaginal prep? What about chlorhexidine? There’s answers for all of these questions, and we will summarize them in this episode.

Duration:00:23:40