Dr. Chapa’s Clinical Pearls.

By Dr. Chapa’s Clinical Pearls

What's Dr. Chapa’s Clinical Pearls. about?

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.

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Dr. Chapa’s Clinical Pearls. episodes:

04.24.2024
Good News for ALPS Follow up?
Our regular podcast family members know that we have been following the antenatal corticosteroid story (especially in the late pre-term/early term interval) for several years now. A variety of countries have now pulled back from recommending corticosteroids in the late...
04.22.2024
Gestational Breast Cancer (PABC)
Breast cancer is the second most common cancer among women in the United States (with skin cancer are the most common). About 9% of all new cases of breast cancer in the United States are found in women younger than...
04.19.2024
Colostrum Harvesting? Do No or Not To Do…That’s The Question.
Historically, colostrum was expressed by women mid- to late-pregnancy with the intent to avoid engorgement and breast trauma in the postnatal period, but it was not stored for use after birth. But storing colostrum antepartum for newborn feeding has gained...
04.18.2024
New Practice Advisory for Syphilis in Pregnancy (April 2024)
From 2012 to 2021, congenital syphilis cases in the United States increased by 755%. According to the CDC, 88% of congenital syphilis cases in 2022 could have been prevented with timely screening and treatment. Despite repetitive messaging about the need...
04.17.2024
Female Low T?
There is a STRONG debate within the medical community as to whether testosterone should be prescribed to women during menopause and the time before and after it. Social media influencers and other media personalities are touting testosterone as a cure-all...
04.15.2024
IV Fe PP, and More
While the importance of optimizing a woman's hemoglobin level during the peripartum period has been emphasized in recent guidelines by the Society for Obstetric Anesthesia and Perinatology, the ACOG, and the Enhanced Recovery After Surgery Society, postpartum anemia remains a...
04.12.2024
Amnioinfusion with IAI? Yay or Nay?
Amnioinfusion was first described in 1976 using a rhesus monkey model. In that landmark study, the authors reported that variable decelerations occurred when amniotic fluid was removed from the uterine cavity and resolved when it was replaced. Although this experiment...
04.10.2024
Acetaminophen (Paracetamol) in Pregnancy and Autism: Latest Data (April 9, 2024)
In 2014, a publication out of JAMA Pediatrics raised questions regarding the safety of acetaminophen in pregnancy describing a possible “association” with later neurodevelopmental and cognitive delays in children. What followed was a string of controversial publications (observational) with mounds...
04.08.2024
When Things Go South: Perinatal PTSD
It has been stated that “Trauma is in the eye of the beholder”. Healthcare providers must be aware that a woman makes experience a birth as traumatic, even if she and her infant are healthy. The ACOG has highlighted perinatal...
04.07.2024
New HDP Med Data: The PYTT Study
In July 2023 and again in November 2023, we discussed the “Rule of 55“ and its role in the management of hypertensive disorders of pregnancy. The Rule of 55 has been mainly applied in the selection of appropriate antipretensive medications...
04.05.2024
The Eclipse’s Effect on Pregnancy ☀️
On April 8, 2024, parts of the United States will be within the Path of Totality for the total solar eclipse. The state of Texas has already declared a state of emergency as visitors flock to the state to witness...
04.04.2024
⭐️NEW⭐️Clinical Practice Update: ACOG Updates PB 222 (Biomarkers for PreE).
Today, April 3, 2024, the ACOG released a clinical practice update to practice bulletin# 222 (gestational hypertension eclampsia). This is in direct response to a recent FDA approved biomarker test for risk stratification for preeclampsia. On May 19, 2023, the...
04.02.2024
New Data Re: Obesity in Pregnancy- Weight Gain Recs, and NPWT at CS
According to the CDC, as well as worldwide data, the percentage of individuals categorized as overweight or obese is rising. First released in 1990 by the IOM, the guidelines for expected weight gain in pregnancy-based on pre-pregnancy weight (BMI)- have...
04.01.2024
The Steroids Saga: New Data, New Debate, New News.
The current dose and schedule for antenatal corticosteroids (ACS) follows the original publication by Liggins and Howie in 1972. That dose and schedule was based on sheep models from the 1960s. The dose in current use had never been evaluated...
03.29.2024
Depo-Provera Causes Brain Tumors?!
Meningiomas are common intracranial tumors with a female predominance. The vast majority of these tumors are benign (World Health Organization [WHO] grade 1) while 15% to 20% of these tumors can behave atypically (WHO grade 2) and rarely, in 1%...
03.27.2024
Balloon For PROM? Yea or Nay
According to the ACOG, pre-labor rupture of membranes (PROM) complicates 10% of all births in the United States and is a major contributor to perinatal morbidity and mortality. What is the best course of action when patients present with PROM...
03.25.2024
Neonatal Subgaleal Hemorrhage: Pearls of Wisdom
Obstetrical vacuum and forceps are incredible tools, when used correctly, to assist vaginal delivery. Appropriately selected and used, they can be pivotal in reducing the number of unnecessary cesareans and potentially decreasing certain fetal and maternal complications. However, there are...
03.22.2024
New Menopause CURE? The Ovarian Autotransplantation Debate
Ovarian preservation by autologous transplantation has given hope to patients desiring future fertility after certain gonadotoxic therapies for malignant conditions. But now, the same procedure is being promoted as a “natural cure” for menopause. Can ovarian tissue-based therapies really be...
03.21.2024
PreMeal or PostPrandial Glucose Checks PP with Type I DM
Since the late 1990s, the standard practice for GDM care has been to measure postprandial glucose values. For patients with pre-gestational diabetes, whether type I or type II, the ACOG recommends multi-level glucose checks (fasting, pre-meal , postprandial, and nighttime)....
03.18.2024
Hep C and BF Confusion (and Updated HIV BF Guidance)
Is breastfeeding with Hepatitis C safe? The answer: Yes! But confusion persists today mainly surrounding the serum hepatitis C viral load. That’s the topic and focus of the new publication released March 2024 in the Green journal, Obstetrics and Gynecology....
03.15.2024
Are ADHD Meds Safe In Pregnancy?
It has been estimated that up to 4.4% of the US adult population has been diagnosed with ADHD. Use of ADHD medication is increasing among pregnant women. In the last several years, there’s been a litany of publications looking at...
03.13.2024
Check the Box: REASSURING NEWs regarding US Maternal Mortality
Four years, the US National Vital Statistics System has reported an abnormally high maternal mortality rate in the United States, showing it to be nearly doubled from 17.4 in 2018 to 32.9 per 100,000 live births in 2021. The United...
03.10.2024
Should We Screen For Thrombophilia Pre-OCP? March 2024 Data
The ACOG, CDC, and WHO currently do not recommend universal screening for thrombophilia in the general population before starting oral contraceptive pills. However, a new publication in AJOG (March 2024) is challenging that stance. In this episode, we will review...
03.08.2024
Metformin in OB and Child's Neurodevelopmental Outcomes (March 2024 Data)
Gestational Diabetes (GDM) is vastly more prevalent in pregnancy compared to pre-existing diabetes. In 2009, the ACOG states that 7% of all pregnancies were complicated by a diabetes diagnosis, with 86% being GDM. The prevalence of GDM keeps rising in...
03.07.2024
OPill…Now HERE! (ACOG PA March 2024)
On this podcast, we have been following this story of the OPill for several months. Previous episodes on the subject can be found in our podcast library. As expected, this first ever daily use progestin only pill is now available...
03.05.2024
GLP1 Agonist Exposure in Pregnancy
Use of second-line noninsulin diabetic medications, like Glucagon-like peptide 1 (GLP-1) agonists and sodium-glucose co-transporter-2 (SGLT2) inhibitors, is rapidly increasing for treatment of T2D and other indications. As these drugs are being used by an increasing group of fertile women,...
03.01.2024
Foley For CX: Tension or No Tension? And More (March 2024 Data)
Using mechanical options as a way to prime/ripen the cervix for labor is nothing new. Balloon catheters have been used for labor induction as far back as the 1890s. Embrey and Mollison reinvigorated the method in 1967 using it in...
02.29.2024
Things That Make You Go Hmmmm
It’s very important to stay up-to-date and current with new data. But sometimes you read something that is hot-off-the press and it makes you just stop and say, “hmmm”. In this episode, we will discuss the new USPSTF position statement...
02.28.2024
GDM Dx with Abnormal Fasting Value: Start Meds?
The “traditional“ Parkland management protocol for GDM included the immediate initiation of medical therapy for those with abnormal fasting blood sugar, in addition to another additional value, on the 3 hour GTT. These patients were automatically labeled as A2 GDM...
02.26.2024
Feb 26, 24 SMFM Position Statement RHIG < 12 Weeks: Confused?
Yes, the subject of RhoGAM/RHIG administration to RH negative patients under 12 weeks gestational age is a continuously controversial issue. We have covered this issue in past episodes, most recently- last month- on January 4, 2024. Today, February 26, 2024,...
02.24.2024
Stage 1 HTN in OB
February 2024 has seen its share of medical and mainstream media stories highlighting hypertensive disorders in pregnancy. While some of this can be considered “old news”, there is “new news” and new developments on the horizon. We have covered hypertensive...
02.23.2024
New Developments in HG
Hyperemesis Gravidarum (HG) has a reported incidence of approximately 0.3–3% of pregnancies. Without prompt recognition and treatment, severe maternal dehydration, electrolyte abnormalities, cardiac arrhythmias, and potentially altered fetal neurodevelopment may result. Recently, HG made medical and general media news as...
02.20.2024
Fetal Manual Rotation: 1st or 2nd Stage Practice?
Women whose fetuses are in the occiput posterior head position at the time of delivery are known to have longer second stages of labor and more complicated deliveries, including more operative assisted births, more 3rd and 4th degree lacerations, PPH,...
02.17.2024
“Formula” to Predict SD?
The ACOG has long-held that shoulder dystocia is “unpreventable and unpredictable”. Nonetheless, as it is a devastating obstetrical occurrence, researchers have attempted to identify a reproducible mathematical formula using ultrasonographic, anthropometric factors to better predict it. What is the data...
02.15.2024
GDM “Screen” in 3rd Trimester?
The ACOG has consistently recommended universal screening for gestational diabetes between 24 and 28 gestational weeks. Although controversial, the ACOG does endorse earlier screening for GDM in patients with additional risk factors. But what about patients who present for prenatal...
02.14.2024
Phthalates and PTB: “New Data”
On February 6, 2024, a new publication in the Lancet Planetary Health received national and international headlines. This study, funded through the NIH, revealed a striking association between certain chemicals in our environment and preterm birth. But is this data...
02.11.2024
Another Nail in the Coffin for Late PT Steroids: New RCT Data
YES, it’s true… Not even Super Bowl Sunday
02.08.2024
New Data on Naltrexone in Pregnancy
We are still in an opioid crisis. The number of women with opioid-related diagnoses at delivery has increased by 131% over the last several years (CDC, Data and Statistics, 2023). The ACOG has recommended the use of opioid agonist pharmacotherapy...
02.07.2024
TOKOPHOBIA: Pregnant & Petrified
It is completely natural, and part of the human experience, to have some anticipatory concern about an upcoming delivery/childbirth. However, when that concern becomes overwhelming, it can develop into a debilitating phobia called Tokophobia. First coined as a term in...
02.05.2024
The OB Steroid WARNING FLAGS: When CONS>PROS
In 1972, Liggins and Howie published their landmark study on the benefits of antenatal corticosteroids (ACS) regarding their reduction of prematurity’s morbidity and mortality. This led to the weekly administration of ACS until 34 weeks. Weekly courses of steroids are...
02.03.2024
Putting LNG-IUS EC In Perspective
On January 28, 2021, a non-inferiority RCT was published in the NEJM, “Levonorgestrelvs Copper T Device for Emergency Contraception”. This study concluded that the LNG 52mg IUD was “noninferior” to the CopperT IUD for emergency BC up to 120 hours...
02.01.2024
The Incredible VIBRATING belt (Osteoboost device): Good Data?
On January 18, 2024, the FDA cleared a novel new device for osteopenia treatment. This is a vibrating belt (wearable device) that transmits low-amplitude, high-frequency (20 to 40 Hz) vibration to the spine and hips. This belt is called Osteoboost....
01.30.2024
Place IUD/S if BV Present? What Would You Do?
Bacterial vaginosis (BV) is the most common vaginal aberrant condition in women, in the general population. Even still, the majority of women with BV are asymptomatic. If BV is found at time of elective IUD/S placement, can the device still...
01.27.2024
More Bad News Re: PreEclampsia
Hypertensive Disorders of Pregnancy (HDP) affect 5 to 15% of women worldwide, and their increasing incidence is likely related to the growing levels of obesity, metabolic syndrome and advancing maternal age. It is widely accepted that women who have preeclampsia...
01.25.2024
OB Issues After IUD Perf?
Uterine wall perforation at time of IUD placement has been published to occur, in general, about 1-2/1,000 cases. It happens! While there are some risk factors for uterine perforation (very antiflexed, retroflexed, recent postpartum state, lactating), sometimes uterine perforation can...
01.22.2024
Extencilline, Linezolid, & STUFF
Yep, Medicine moves fast! On Friday, January 5, 2024, I participated in a medical news report published in “The Guardian”. In that news commentary I stated that “Bicillin-LA is the only medication approved for syphilis during pregnancy”. We’ve all heard...
01.21.2024
Preg Test in ESRD: Going Down the Rabbit Hole?
If you had 5 reproductive age women, all late on their menstrual cycle, who were having unprotected sex, and all have a positive pregnancy test… What would be your diagnosis? The most likely diagnosis would be that there are five...
01.18.2024
You Asked, We Answered!
Periodically, we respond to podcast family members’ questions as data is available. In this episode, we will cover 3 very clinically relevant questions from our podcast listeners. The first question is regarding our immediate past podcast topic, which was propranolol...
01.17.2024
Can Propranolol Rescue Labor?
It has been well reported that rates of elective induction have risen nationally and internationally since the adoption of the ARRIVE trial. But as medicine is at times controversial, some studies have suggested an increase in cesarean section rates with...
01.15.2024
More Data on LUST (Follow up to 12/31/23 Episode)
On New Year’s Eve 2023 we released “LUST for TOLAC”. LUST stands for lower uterine segment thickness. This is a very enticing, and controversial, approach to TOLAC counseling and direction. I encourage you to go back and listen to that...

What's Dr. Chapa’s Clinical Pearls. about?

Download our free app to listen on your phone

Dr. Chapa’s Clinical Pearls. episodes:

Good News for ALPS Follow up?

Gestational Breast Cancer (PABC)

Colostrum Harvesting? Do No or Not To Do…That’s The Question.

New Practice Advisory for Syphilis in Pregnancy (April 2024)

Female Low T?

IV Fe PP, and More

Amnioinfusion with IAI? Yay or Nay?

Acetaminophen (Paracetamol) in Pregnancy and Autism: Latest Data (April 9, 2024)

When Things Go South: Perinatal PTSD

New HDP Med Data: The PYTT Study

The Eclipse’s Effect on Pregnancy ☀️

⭐️NEW⭐️Clinical Practice Update: ACOG Updates PB 222 (Biomarkers for PreE).

New Data Re: Obesity in Pregnancy- Weight Gain Recs, and NPWT at CS

The Steroids Saga: New Data, New Debate, New News.

Depo-Provera Causes Brain Tumors?!

Balloon For PROM? Yea or Nay

Neonatal Subgaleal Hemorrhage: Pearls of Wisdom

New Menopause CURE? The Ovarian Autotransplantation Debate

PreMeal or PostPrandial Glucose Checks PP with Type I DM

Hep C and BF Confusion (and Updated HIV BF Guidance)

Are ADHD Meds Safe In Pregnancy?

Check the Box: REASSURING NEWs regarding US Maternal Mortality

Should We Screen For Thrombophilia Pre-OCP? March 2024 Data

Metformin in OB and Child's Neurodevelopmental Outcomes (March 2024 Data)

OPill…Now HERE! (ACOG PA March 2024)

GLP1 Agonist Exposure in Pregnancy

Foley For CX: Tension or No Tension? And More (March 2024 Data)

Things That Make You Go Hmmmm

GDM Dx with Abnormal Fasting Value: Start Meds?

Feb 26, 24 SMFM Position Statement RHIG < 12 Weeks: Confused?

Stage 1 HTN in OB

New Developments in HG

Fetal Manual Rotation: 1st or 2nd Stage Practice?

“Formula” to Predict SD?

GDM “Screen” in 3rd Trimester?

Phthalates and PTB: “New Data”

Another Nail in the Coffin for Late PT Steroids: New RCT Data

New Data on Naltrexone in Pregnancy

TOKOPHOBIA: Pregnant & Petrified

The OB Steroid WARNING FLAGS: When CONS>PROS

Putting LNG-IUS EC In Perspective

The Incredible VIBRATING belt (Osteoboost device): Good Data?

Place IUD/S if BV Present? What Would You Do?

More Bad News Re: PreEclampsia

OB Issues After IUD Perf?

Extencilline, Linezolid, & STUFF

Preg Test in ESRD: Going Down the Rabbit Hole?

You Asked, We Answered!

Can Propranolol Rescue Labor?

More Data on LUST (Follow up to 12/31/23 Episode)