Dr. Chapa’s Clinical Pearls.

This podcast discusses the updates in obstetrical care consensus for labor management, including changes in the approach to latent labor, second stage labor, and amniontomy. It emphasizes clear communication with patients and individualized care, as well as the challenges in determining full dilation during labor and the importance of immediate pushing after complete dilation.

New evidence suggests that GDF15, not estrogen or HCG, is likely responsible for nausea and vomiting of pregnancy. This discovery opens up new therapeutic possibilities. The podcast explores the role of GDF15 in pregnancy sickness, its functions in the body, and its potential for developing medications. It also discusses the association between GDF15 and nausea/vomiting, and its potential use in weight loss medication.

Learn about the updated perspective on using AMH levels in the diagnostic criteria for PCOS in the 2023 guidelines. Understand the importance of evidence-based practices in medicine, body weight, and self-love. Explore the challenges of recording amidst a busy schedule and the controversy surrounding the specificity of polycystic ovarian morphology. Discover the role of AMH in PCOS diagnosis, its limitations, and the importance of clinical assessment. Finish the podcast with gratitude for listener feedback and an update on PCOS and AMH.

We thought we had endometriosis all figured out. After all, we know it’s a chronic pain syndrome that’s hormone responsive. But there’s more to it than that. Within the last few years, including this year 2023, we have grown even more in our understanding of this pelvic pain condition. We now have new data explaining the link between endometriosis and migraine attacks. Are you familiar with CGRP? While most attention has focused on this biochemical messenger’s role in migraines, CGRP is also related to endometrial implants. In this episode, we will do a deep dive into the shared pathophysiology of endometriosis and migraine headaches. We will look at the role that CGRP and TRPV1 play in both of these pain conditions.

This podcast explores the issues and interventions related to intraventricular hemorrhage (IVH) in preterm babies. It discusses the impact of mode of delivery on IVH, the benefits of antenatal corticosteroids and magnesium sulfate, and the importance of neonatal vitamin K administration. The podcast emphasizes the need for collaboration between obstetricians and neonatologists to provide evidence-based care and addresses the controversial topics surrounding IVH prevention methods.

We are definitely a “DIY“ society. And now, consumers can add DIY Insemination to that list! On December 6, 2023 the FDA cleared the first device for at home insemination. This over-the-counter option will be available in 2024. In this episode, we will review this landmark and historic device clearance. We will also clarify the distinction between FDA “approval” and FDA “clearance”. Who is best suited to use this device? Is this considered first-line for unexplained infertility? Lots of interesting questions, but we have the answers. Listen in and find out more.

Amniotic fluid embolism remains one of the most devastating conditions in obstetric practice with an incidence of approximately 1 in 40,000 deliveries. The associated mortality for this condition has been reported to be 20% at the low-end, to 80% at the high-end. The use of atropine (1 mg intravenously [IV]), ondansetron (8 mg IV), and ketorolac (30 mg IV) (AOK) as an adjunctive treatment has been widely discussed by obstetric providers as a treatment option which should be considered to supplement other treatment modalities. In this episode, we will review the pathophysiology of AFE and discuss its first-line treatment regimens, as well as the AOK/AOK – T protocol.

Management of CINI is straightforward, as is management of CIN3. CIN1 allows for observation, and CIN3 requires treatment regardless of the patient’s age as it is a true pre-cancerous lesion. But some “gray zone“ exits for CIN2 management. Population-based data has confirmed a high rate of spontaneous resolution within 2 years after CIN2 diagnosis. Is the rate of cervical cancer higher in this surveillance group compared to immediate LEEP? In this episode, we will highlight 2 separate publications, each originating from the same patient database (Danish population-based cohort). These 2 publications are from the same group of authors with one publication coming from the AJOG (December 2023), and the other one published last month in BMJ (November 2023).

This podcast explores the relationship between PCOS and insulin resistance, the importance of monitoring insulin levels, and different tests for insulin resistance. It discusses the association between insulin resistance and various medical conditions, the significance of screening for IR in patients with PCOS, and testing insulin levels in hyperinsulinemia. The podcast also explores different diagnostic criteria for PCOS, discusses the gold standard test for hyperinsulinemia, and compares various diagnostic tests for diabetes and insulin resistance.

On July 30, 2023 we released an episode describing the hypertensive “rule of 55” otherwise known as the physiologic approach to hypertension management. The rule of 55 breaks down hypertension into either hyperdynamic/high cardiac output in origin, or systemic vascular resistance in origin. There is plenty of evidence to support this management approach. Late this evening, on November 30, 2023, Obstetrics and Gynecology released a new research letter ahead of print, providing more insights on the physiologic approach to hypertension management. In this episode, we will briefly cover this brand new publication, released just 2 hours ago, and provide clinical application perspectives.