Dr. Chapa’s Clinical Pearls.

Exploring the complexities and controversies of non-invasive prenatal testing (NIPT) for sex chromosome abnormalities. Highlighting the need for separate analysis and the ethical concerns surrounding this screening method. Discussing limitations, interpreting abnormal results, and the potential consequences of false results. Sharing a personal story about bronchitis and the growing podcast community. Discussing an unusual medical case presented by a resident, while emphasizing important clinical facts.

In this podcast, the speaker discusses two interventions in pregnancy that lack strong evidence: "test of cure" urine culture after treatment of ASB or cystitis, and specific yoga positions/Miles circuit as preparation for labor. The controversy surrounding the necessity of a repeat urine culture and the potential complications of asymptomatic bacteria in pregnancy are explored. The benefits of different positions during labor and physical activity in late pregnancy, such as reducing anxiety and shortening labor duration, are also discussed.

This podcast discusses the advancements in NIPS for identifying fetal RH genotype, preventing hemolytic disease of the newborn through Rogam, updates on RH testing and treatment guidelines, molecular testing for autosomal recessive conditions, and the introduction of a NIP test revolutionizing RH negative mothers' care.

Historically a range of psychiatric and medical conditions have been erroneously attributed to 2 gynecological organs/function. During the time of Hippocrates, the “wandering womb” theory blamed emotional disturbances in women on this condition. Not only was that erroneous, it was nonsensical. However, certain gynecological conditions can indeed manifest with neuro-behavioral disturbances. One of these syndromes can be triggered by the presence of an ovarian dermoid. Anti-N-methyl-D-aspartate receptor (NMDA-R) encephalitis is a paraneoplastic limbic syndrome which may be caused by ovarian teratomas containing neural components. Neural tissue in a teratoma can trigger the production of anti-NMDA-R antibodies, which causes neuronal dysfunction and loss by altering the neuronal cell-surface NMDA receptors in the limbic system. This syndrome presents with a range of psychiatric, neurological and autonomic features and if not promptly recognized and treated may be associated with long-term morbidity and mortality. Rare…yes. But it is out there in the community and patients are at HIGH risk of misdiagnosis. In this episode we will discuss this “Brain on Fire” syndrome and highlight a real case contributed by one of our podcast family members (HIPPA protected).

Exploring the controversy around measuring lower uterine segment thickness (LUST) for TOLAC approval. Discussing the complexities and controversies of this measurement. Highlighting the challenges and concerns of multiple C-sections and TOLAC. Comparing different studies and expressing skepticism towards suggested evaluations. The Lower Uterine Segment Trial (LUST) found no significant decrease in adverse outcomes with ultrasound measurements. Emphasizing the importance of conducting randomized controlled trials in the medical field.

It’s no surprise and understatement to say that the US maternal/neonatal morbidity and mortality rates have to improve. As a way to increase maternal supportive care, an increasing number of states are turning to cover Doula services. Despite this forward thinking, there are still misperceptions, misunderstandings, and “boundary” issues regarding Doulas which must be addressed. Are Doula interventions evidence based? Are Doula services related to improved maternal and neonatal outcomes? What is the position from the ACOG? Does the March of Dimes have a position statement? We will answer all of these questions and explain why 2024 may be the “Year of the Doula” in this episode.

The podcast explores the concept of slowed fetal growth as a risk factor for stillbirth. They introduce new data validating this concept and discuss a free online fetal growth trajectory calculator. The significance of tracking fetal growth trends through ultrasounds is emphasized, along with the risks associated with stillbirth. The implications for delivery and the importance of serial ultrasounds and patient education are also discussed. A study assessing different models to predict stillbirth risk based on fetal growth is highlighted.

The podcast discusses the updated guidelines for managing Hepatitis B in pregnancy. Topics include vaccination, screening, and medication during pregnancy, the risk factors for perinatal transmission, and the management of positive viral infections. The importance of neonatal immunoprophylaxis, monitoring liver function, and adult vaccination are also highlighted.

This podcast explores the correlation between height stature and various health conditions, including the risk of certain cancers and venous thromboembolism. It delves into the impact of maternal short stature on obstetrics outcomes and discusses population-specific guidelines. The podcast also discusses the limitations of BMI in measuring weight and health in individuals of different heights and highlights the relationship between maternal height and adverse perinatal outcomes.

Sex has always had its share of misinformation, even as it relates to some medical conditions- like epilepsy. "Coitus brevis epilepsia est" ("Sex is a brief seizure") is an ancient proverb attributed to Galen, the influential Greek physician and philosopher in the Roman Empire. Then, in the 18th and 19th centuries, some physicians, including Samuel-Auguste Tissot and Edward Sieveking, argued that excessive masturbation could cause epilepsy! At the time, castration and clitoridectomy (removal of the clitoris) were reportedly performed on people with severe epilepsy. Terrible! Thankfully we now are all SURE that sex does not CAUSE epilepsy, but sexual release (orgasm) and seizure like activity are indeed similar. Can orgasm trigger epilepsy? And is the reverse possible: can seizures give orgasm like effect? How is PNES related to this? We will review this fascinating clinical conundrum in this episode.