Dr. Chapa’s OBGYN Clinical Pearls

Welcome to our “OB Smorgasburg” episode, where we have a CORNUCOPIA of topics. Well, maybe not a full cornucopia… But a mini-cornucopia. In this episode, we will address 2 recent publications that really are my “pet peeves“ about medical data! One is from the US Preventive Service Task Force, and the other has to do with “timed intercourse”. You have to listen to this! Then we will get into new data regarding the association of 1 abnormal glucose value on the 3 hour GTT with adverse neonatal outcomes. And lastly, is there such a thing as “organic” 50 g glucose challenge? Let’s get into all this information…Now!

This podcast explores the effectiveness of weekly lab screening for hypertensive disorders in pregnancy. It discusses the importance of staying up to date with recent data and evidence-based practice. The necessity of close monitoring and weekly lab tests for preeclampsia is also highlighted. The distinction between insufficient evidence and no evidence is explored along with the recommendation for targeted lab screening for symptomatic patients.

Trichomoniasis is a prevalent nonviral STI worldwide, with significant complications and associations. Despite its impact on women's health, it remains a neglected and non-reportable illness. This episode explores the frustration surrounding the lack of urgency, screening guidelines, and public information. It discusses the link between T vaginalis infection and higher HIV risk, the criteria for reporting an STI, and the need for prevention efforts and reduced healthcare disparities.

Should metformin be continued in PCOS pregnancies? This episode discusses the data and guidelines for managing metformin use during pregnancy in women with PCOS. Topics include the impact on miscarriage rates, gestational diabetes, and the child's BMI. It also explores the importance of reproductive maturity, early diabetic screening, and counseling patients about the risks and benefits of metformin use during pregnancy.

NSAIDs have been shown to be associated with development of VTEs. This data is not new, but is more than 10 years old. Of course, hormonal contraception is also known to potentially increase the risk of VTE depending on the amount of estrogen in the combination product as well as the type of progestin used. So, a reasonable question to ask is whether the use of these two medications TOGETHER synergistically increase the risk of VTE. A recent publication in BMJ (06 Sept 2023) provided some controversial results in this very topic. Could those study results be the result of "indication bias" or protopathic bias? In this episode we will look at the data, summarize the key results, review the study limitations, and provide some real world clinical insights as to what to do with this new info.

Exploring the debate on single- vs double-layer closure at cesarean section. Importance of foundation and decidua in closure. Critiques on closure techniques. Lack of consensus among surgeons. Importance of tissue approximation over number of layers in uterine closure during hysterectomy.

A uterine niche is a reservoir-like pouch in the anterior uterine isthmus located at the site of a previous CS scar. First published and describe din 1961, there have been a variety of publications looking at "best practice" at cesarean hysterotomy closure to try to minimize its occurrence. This defect has been linked to abnormal placentation in subsequent pregnancies, CS scar ectopic pregnancies, abnormal uterine bleeding, and dysmenorrhea. While the complete pathogenesis of the niche defect is not completely understood, hysterotomy closure techniques have been implicated in its formation. Should we include the endometrial decidual layer at hysterotomy closure or should we exclude it. Its a debated subject but the data does favor one approach over the other. In this episode, we will examine that data.

Exploring the challenges of diagnosing and managing SLE in pregnant patients, including the importance of diagnostic criteria, antibody testing, and disease remission. Discussion on medication management, fetal heart health surveillance, and delivery timing for patients with SLE.

This podcast explores the relationship between celiac disease and fertility/pregnancy outcomes, the history of celiac disease and the influence of diet, and common biases and misconceptions of celiac disease. It emphasizes the importance of correct diagnosis and management during pregnancy and highlights the implications of celiac disease for women's health.

Probiotics may be good for your gut, but does your vagina need them too? Probiotics are in everything from fermented drinks to pills and powders, and in many cases, are being advertised as a way of improving your vaginal health. Is that evidence based? Do oral probiotics help support a healthy vaginal microbiome? What about vaginal probiotics? Can vaginal probiotics augment BV therapy? The answer may surprise you. So…Grab your kombucha and take a seat… We’re going to cover this and much more, in this episode. 😊