Dr. Chapa’s OBGYN Clinical Pearls

We recently provided some additional information regarding the recently approved medication for postpartum depression, Zoranalone. One of the benefits of this medication is it’s rapid mechanism of action. Although not yet approved for major depressive disorder outside of the perinatal interval, there is a separate medication, which was FDA approved last year, which is ultra-fast acting for depression. Oddly enough, one of its main ingredients is a traditional cough suppressant. Have you heard of this medication? In this episode we will review this incredible development AND highlight some cautionary ⚠️ details.

As a true testament that we read each one of our Podcast Facebook messages, this is a “You asked, We answered” episode regarding 3 main recent topics: 1. dose of oral MI for PCOS, 2. Zoranalone for Major Depressive Disorder, and 3. the “shoulder shrug” maneuver for shoulder dystocia. 👍👍👍👍

Polycystic ovary syndrome (PCOS) affects many women and is linked to insulin resistance. The podcast delves into how myo-inositol and D-chiro-inositol can potentially reverse metabolic challenges associated with PCOS. It discusses the effectiveness of these inositols in normalizing menstrual cycles and improving fertility. Unlike metformin, which can cause significant gastrointestinal side effects, these natural alternatives present a promising path forward for managing PCOS symptoms and metabolic health.

This podcast discusses the updated guidelines for Hepatitis B in pregnancy, including the new national recommendations for testing and screening. It highlights the importance of the Hep B triple screen in detecting infection. The podcast also covers the use of antiviral therapy and recommendations for preventing perinatal transmission of Hep B.

OK, OK…we all get that past history of DVT related to hormonal exposure is a true and persistent contraindication for estrogen birth control. We get that. But what about the incidental presence of lower extremity varicose veins? Are varicose veins a contraindication to estrogen containing birth control? After all, some data has linked superficial varicose veins to the development of DVT. That must mean that estrogen containing BC is contraindicated due to the additional risk of clot formation, right? Is that true? There is some STRANGE information on the internet regarding the association of oral birth control pills and varicose veins. Do combo OCPs cause varicose veins? Do they increase the risk of DVT in those with varicose veins? In this episode we will explore the science, data, and published guidelines related to the prescribing of estrogen containing birth control in patients with varicose veins. PLUS, we will cover which patients- who do by chance develop a superficial venous thrombus in a varicose vein- need anticoagulation.

On August 21, 2023, the FDA approved a new RSV vaccine for maternal use, ideally in the late third trimester. However, there are some nuances and some cautionary notes here! In this episode, we will review the phase 3 data, which fostered the FDA approval and review the nuances to this study. Are we ready for mass incorporation of the maternal RSV vaccine into clinical practice? The answer quite simply is… “No”. We will explain why in this episode.

In 2015, the ACOG released its Committee Opinion on "Endometrial Intraepithelial Hyperplasia", or EIN (CO 631). EIN is of clinical significance because it is often a precursor lesion to adenocarcinoma of the endometrium. Making the distinction between hyperplasia and true precancerous lesions or true neoplasia is super important because their differing cancer risks must be matched with an appropriate intervention to avoid under/overtreatment. As is our podcast tagline, "medicine moves fast"; coming out in September 2023, the ACOG will release a new Clinical Consensus guideline on "EIN-AEH". What are the new changes? Why are we moving from a EIN designation to EIN-AEH? Is a progestin IUS a reasonable therapeutic option for those wishing to preserve fertility after this diagnosis? In his episode, we will answer all these questions and more, focusing on this new Clinical Consensus guideline.

A recent national news-worthy birth event involving shoulder dystocia sparks a discussion on vital tips and techniques for managing this condition. Topics include risk stratification, primary cesarean section, evaluation of maneuvers, factors affecting success, super pubic pressure and Ruben's maneuver, and limitations of the all fours maneuver.

Access to effective oral emergency contraception is vital, now more than ever. While use of either levonorgestrel or ulipristal is endorsed by the ACOG, pharmacodynamic and clinical data does show that ulipristal has the efficacy advantage. Although the process of ovulation is directed by the LH surge, it is also put into action by prostaglandin resulting from COX2 activity. So, can the addition of a COX2 inhibitor increase the efficacy of Plan B when taken as a combo? A new study published 24 hrs ago in the Lancet provides some exciting data. We will cover this new RCT, and more, in this episode.

Persistent genital arousal disorder (PGAD), now called Genito-Pelvic Dysesthesia, was first described by Leiblum and Nathan in 2001 in a five-patient case series. This is now a well-recognized pelvic floor/genital abnormality with a consensus statement being released in 2019 by the International Society for the Study of Women's Sexual Health. Are you familiar with this condition? It is a source of severe emotional and mental hardship for those affected. In this episode, we will summarize the data on this strange but very REAL condition that is NOT related to sexual desire or sexual arousal.