Dr. Chapa’s OBGYN Clinical Pearls

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.

A striking 15-20% of women will deal with ovarian cysts in their lives, sparking considerable anxiety. The discussion navigates the O-RADS scale, offering a standardized method for assessing these cysts, much like its counterpart for breast imaging. It also highlights the limitations of tumor markers in premenopausal women, stressing the need for a holistic approach in management. Recent studies reveal that many cysts, especially in younger individuals, may resolve naturally, challenging pre-existing assumptions about these common health concerns.

The word clitoris comes from the Greek word, “kleitoris” which means “little hill”. In 1559, the clitoris was “discovered” by an anatomist Renaldus Columbus who called it the “love of venus” and concluded that its primary function was strictly for pleasure. It is quite shocking 2 believe, although true, that the first anatomical paper on the clitoris was published only in 1998 and its anatomy, using MRI, fully described in full in 2005. This lack of scientific attention, until recently, to both the anatomical structure and true functioning of the clitoris is equally shameful as it is shocking. It is no wonder that vast misunderstandings of such a vital structure for female sexual well-being persist even today. In this episode, we will review an eye opening, and sad, recent publication released on October 15, 2023 in the Australian and New Zealand Journal of Obstetrics and Gynecology. How well do we truly understand clitoral anatomy? Apparently, not well at all! As Women's Health care providers, we must realize that the results of that study are not only disappointing but that we must also advocate for more information and education pertaining to the mysterious little bean. How is our understanding of the clitoris related to Napolean Bonapart, and to Sigmund Freud? How is the Clitoris-Vaginal Distance related to orgasm? And what is the actual wishbone anatomy of the clitoris? Listen in and find out.

The podcast discusses the occurrence of uterine rupture in the unscarred uterus, highlighting the risk factors and emphasizing the importance of awareness. It explores the symptom of fetal heart rate changes and the increased risk associated with gynecological red flags. Risk factors for intra-partum rupture are also discussed, including prolonged labor and uterine anomalies. The podcast also explores the association between endometriosis and uterine rupture, discussing the effects on placentation and pregnancy risks.

Discover the timely alignment of clinical opinions on postpartum hypertension and the role of magnesium sulfate in care. Insights reveal the importance of personalized strategies in treatment amid ongoing research gaps. Explore the uncommon occurrences of eclampsia beyond a week postpartum, alongside the speaker’s reflections on empathy in healthcare and the vital support of family. It's a fresh perspective that emphasizes both clinical knowledge and human connection in managing severe postpartum conditions.

Data has shown that more than half of maternal deaths occur past the traditional 6 week postpartum mark. This is why the ACOG recognized the “fourth trimester” in 2018 (ACOG CO 736), reflecting the fact that the patient is still at risk beyond the first 6 weeks after delivery. One of the main areas of focus postpartum is on hypertension care. Growing understanding of the long-term implications of HDP and other medical complications of pregnancy have led to an increasing focus on building transitions from postpartum care to primary care, which will be essential for the long-term wellbeing of women with postpartum hypertension. How many women will develop new onset hypertension more than 6 weeks from delivery? At what blood pressure cut off should anti-hypertensive medication be considered postpartum? Should it be at 150/100 or 140/90? Which medication is preferred for postpartum use? Is magnesium sulfate for severe range blood pressures effective as seizure prevention beyond 7 days postpartum? We will tackle these questions, and more, in this episode.

This podcast discusses the lack of updates in A-Cog's practice bulletin on asthma in pregnancy and introduces new recommendations from Gina. It covers topics such as the impact of asthma on fetal growth and maternal quality of life, the use of biologics in pregnancy, and the importance of inhaled corticosteroids in treating asthma.

It’s a universal nomenclature… The TPAL system. Despite its traditional and long-standing integration into obstetrical vernacular, there are significant gaps in this system. And, although we use these terms daily, there is controversy about what one of those elements actually means. What is the “L“ actually for? We’ve all learned it as “living children”. But what does that actually mean? Is that live births? Is it number of living children at time of the report? Or does it mean something entirely different? In this episode, Dr. Katie Light joins me as we have a fun time looking into the data. Hang out with us until the end of the episode, because I will give us some practical insights for using the TPAL nomenclature.

This episode is our NEWS BRIEF. Yesterday, on November 15, 2023, the FDA approved the first, patient self-collected, home test kits for GC and Chlamydia. This is a BIG advancement for women's health. But, this is actually not the first at home STI test to be approved. In this episode, we will review this new FDA approved test, the specifics of the product, and why this is not just a "direct to consumer" purchase item.