Dr. Chapa’s Clinical Pearls.

Exploring the controversy around placing an elective IUD in patients with bacterial vaginosis. Different perspectives and guidelines are discussed, highlighting the confusion surrounding this topic. Contradictions between manufacturer and CDC guidelines are addressed, emphasizing the importance of protecting the device. The lack of consensus and guidelines on BV screening before IUD insertion is highlighted.

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 are at increased risk of future hypertension, cardiovascular disease, stroke, chronic kidney disease, and even diabetes in later life. But what is the association between HDP and dementia? In this episode, we will review the latest data from a systematic review and meta-analysis published on January 24, 2024 in the AJOG.

The podcast discusses the topic of uterine wall perforation during IUD placement and the potential future obstetrical complications. It explores the risks, management strategies, and associated complications of uterine perforation. A case report is presented, highlighting the impact on pregnancy and discussing a rare case of uterine rupture following a previous perforation. The podcast also mentions the increased risk of uterine rupture with hysteroscopic surgery.

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 that statement, and it is a true statement. However, 5 days later on January 10, 2024, the FDA announced the importation allowance of “Extencillin” to combat the Bicillin-LA shortage. Yep, Medicine moves fast. Now we have this medication available as an option until Bicillin-LA increases its availability. But what about Linezolid? In this episode, we will also discuss a recent non-inferiority trial of Linezolid for early syphilis, which was published in “The Lancet”. Although that study had disappointing results, there are some caveats which need explaining. Listen in to find out more.

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 pregnancies! Right?! But what if 1 of those patients had end stage renal disease (ESRD), on hemodialysis. Is there anything else to consider? While ruling out pregnancy is priority #1, it is possible that this HCG is a phantom result. This is a slippery slope discussion and one that could easily lead down the rabbit hole. In this podcast, we will highlight this clinical conundrum, based on a real case from our practice, and summarize some fascinating reports from the literature.

This episode of the podcast covers clinically relevant questions from listeners, including the use of propranolol in labor, the link between birth control pills and depression, and the HPV booster vaccination after CIN2+ treatment. It provides new research, ACOG guidelines, and discusses the controversy surrounding the pill and depression. The impact of birth control pills on mental health and the use of HPV vaccine as an adjuvant for CIN patients are also explored.

The podcast explores the conflicting evidence on the effectiveness of using propranolol for rescuing labor. It discusses recent studies, safety, and effectiveness of propranolol and calcium carbonate in labor. The debate over the efficacy of propranolol in rescuing dysfunctional labor is explored, highlighting the importance of systematic reviews. The use of propranolol in managing dysfunctional labor is discussed, emphasizing the controversial evidence but highlighting its potential role in decision-making.

The podcast discusses the use of lower uterine segment thickness (LUST) in the prediction of TOLAC uterine rupture. It highlights the PRISMA study, a multi-center trial that provides more data on the application of LUST. Controversy surrounding total act calculators and ethnicity in their calculations is explored. The podcast also delves into the use of the VBAC calculator and LUST in predicting VBAC success, as well as the potential of LUST to reduce uterine rupture rates and perinatal morbidity. The episode concludes by addressing the controversy surrounding the concept of LUST for TOLAC and the need for further research.

The podcast explores the shifts in viability for premature infants, focusing on the ability to resuscitate and care for babies as young as 22 weeks and weighing as little as 500 grams. Ethical debates and commentaries surrounding this advancement are discussed. The challenges and potential complications of neonatal resuscitation at 22 weeks and the impact on long-term baby health are explored. The chapter also delves into survival rates, neurodevelopmental outcomes, and factors affecting the outcomes of babies born between 22 and 28 weeks.

This is NOT our regularly scheduled episode. Based on an incredible comment from Rachel – one of our podcast family members, which I received just moments ago, this was too good to not put out. A brief clarification on NIPTS and “46XX or 46XY”. (This is a supplement to our immediate past episode.) 😊😊🧐🧐