Dr. Chapa’s OBGYN Clinical Pearls

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.

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).