Dr. Chapa’s Clinical Pearls. - podcast cover

Dr. Chapa’s Clinical Pearls.

Dr. Chapa’s Clinical Pearlspodcasters.spotify.com
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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Episodes

New PTB Prevention Bulletin: ACOG Aug 2021 (PB 234). Part 1

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.

Aug 01, 202112 min

NSGU (Lipschütz ulcers): Painful sores in virginal patients.

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.

Jul 27, 202111 min

Stop BF After Covid Vaccine? Yes or No?

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.

Jul 23, 20217 min

Cholestasis of Pregnancy: SMFM Consult #53 (2021)

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.

Jul 19, 202116 min

Why we do this!

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.

Jul 12, 20212 min

Atypical Breast Hyperplasia

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.

Jul 09, 202111 min

Perinatal Fe Deficiency Facts

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.

Jul 05, 202110 min

Nifedipine tocolysis? No (July 2021 Green Journal)

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).

Jul 01, 202113 min

Ad-Hoc Med Translators: Take Caution.

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 us...

Jun 27, 20219 min

GO MOMs! A New NIH Study for GDM

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.

Jun 23, 20218 min

LEEP or CKC? Part 2

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

Jun 20, 202110 min

LEEP or CKC? A Review of ASCCP Guidelines for HG Dysplasia (Part 1)

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.

Jun 16, 202117 min

Evidence Based Hysterotomy Closure

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.

Jun 14, 202115 min

Mag for RLS? Allison’s Inquiry.

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.

Jun 10, 20219 min

RLS in Pregnancy (Part 2)

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

Jun 10, 202115 min

RLS in Pregnancy (Part 1)

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.

Jun 07, 20219 min

Brexafemme: Helpful, or Not?

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!

Jun 03, 20217 min

Intracervical Balloon After PROM: June 2021 Meta-Analysis (AJOG).

PROM complicates 8% of term pregnancies, approximately 270,000 births in the US annually. In this session, we summarize and review a June 2021 Systematic Review/Meta-Analysis (of RCTs) where an intracervical balloon catheter was compared with a pharmacologic agent for the induction of labor after PROM,including preterm PROM.

Jun 02, 202112 min

Hep C Screening (ACOG Advisory May 2021)

Hepatitis C is the most commonly reported bloodborne infection in the United States. The ACOG is updating its Hepatitis C screening guidance regrading pregnancy. In this session, we will review the May 2021 ACOG Practice Advisory regarding hepatitis see screening in pregnancy.

May 29, 20216 min

The Obese CS Patient

The ACOG will release a new Practice Bulletin in June 2021 discussing obesity in pregnancy. The prevalence of obesity in reproductive age women in the United States is 39.7% In this session we will review some key practical issues regarding cesarean sections in the obese patient. Is one type of skin closure better than the other? What is the optimal VTE pharmacological protocol? Tune in and see!

May 26, 202115 min

Myth-Busting: Preeclampsia Episode (Part 2)

The information in this section will shake your foundation regarding what you had previously been told about the origins of preeclampsia. Is the placenta the villain or the victim? This is Part 2 of our Myth-Busting Preeclampsia Episode. We will review the maternal cardiovascular changes that actually PRE-EXIST the development of preeclampsia.

May 23, 20218 min

Myth-Busting: Preeclampsia Episode (Part 1)

The pathophysiology of preeclampsia continues to be discovered. For decades, the placenta has been portrayed as the “villain“ in the preeclampsia saga. But is it? Evolving data is putting that into question and is eliminating previously held concepts previously thought to be true. In this episode we will myth-bust some long-standing beliefs regarding preeclampsia.

May 20, 202118 min

High vs Low-Dose Pitocin: Safety and Effectiveness.

Is the high dose Pitocin protocol (6 mU/min) associated with increased C-sections for fetal distress? What about perinatal outcomes? There are a variety of Pitocin protocols in L&D units across the country. In this episode, we will review a soon to be released publication out of Obstetrics and Gynecology. We will summarize an RCT comparing high-dose versus low-dose Oxytocin for labor augmentation in nulliparous women.

May 17, 202113 min

Term Birth Issues after BMZ?

Given the known benefits to BMZ for preterm infants and the difficulty in predicting which women will actually deliver preterm, it is common for providers to administer antenatal corticosteroids in an effort not to miss the opportunity to give them before delivery and to try and get the maximal time benefit. However, many of these babies will be born at term. Do these term born babies benefit or experience adverse outcomes after steroid exposure? In this session, we will review an article that i...

May 13, 202110 min

Vitamin S: Can Sexual Frustration Cause Depression?

Sex can fulfill the human psychological needs of connectedness as well as the physical needs of intimacy. Being alone and lonely can cause major health and psychological problems for many. Is there data that sexual frustration impairs well-being? This session will review this often controversial subject as well as summarize an eye-opening study previously published from Carnegie Mellon describing state of happiness based on frequent of sex.

May 11, 202113 min

Adenomyosis (Part 2)

In this session we wrap up our review of Adenomyosis. Are you familiar with the MUSA ultrasound criteria? What is the role of MRI in the diagnosis of Adenomyosis? And is there a role for hysteroscopic diagnosis? Let’s wrap up our discussion on Adenomyosis now.

May 06, 202111 min

Adenomyosis (Part 1)

Historically, Adenomyosis was a pathological diagnosis only. However, new imaging standards/techniques have moved Adeno into a clinical diagnosis. Is there a patient risk profile for this condition? Is this strictly a gynecological issue or is there adverse perinatal outcomes as well? Welcome to Part 1 of Adenomyosis where we will answer these questions and more.

May 02, 202112 min

Mood Disorders in Admitted Antepartum Patients: LOOK FOR IT!

OB Patients admitted with medical or obstetrical complications to an antepartum hospital unit face separation from loved ones, stress from their diagnosis, face isolation, and are prone to develop perinatal mood disorders. In this episode, we will review a soon to be released publication from the Green Journal (May 2021) addressing this under diagnosed and under recognized issue.

Apr 28, 20219 min

The 4th Trimester: Not Long Enough.

On April 12, 2021, Illinois agreed to provide Medicaid benefits to eligible mothers for up to 12 months postpartum, a major extension from the previous 60-day limit. Follow up of postpartum women for 12 months after delivery is gaining favor as data is evolving which shows that “the 4th trimester” (the first 12 weeks postpartum) is just not long enough to detect postpartum complications. In this episode we will review a new editorial which states that “the 4th trimester” is not long enough.

Apr 23, 20219 min

The Acutely Agitated OB Patient

We often encounter the acutely agitated patient. Acute agitation may be from and uncontrolled medical condition, psychiatric condition, or illicit substance induced. The acutely agitated patient is also at increased risk of some prenatal complications. In this session we will review the evidence-based protocols for management of the acutely agitated OB patient.

Apr 21, 202116 min
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