Dr. Chapa’s Clinical Pearls.

Up to 70% of women who are anticoagulated will experience episodes of heavy menstrual bleeding. Traditionally, progestin only hormonal agents have been used in these cases. Can combination birth control pills be used in the anticoagulated patient? Is there data regarding their safety? In this episode, we will walk down the data timeline starting in 2009 and ending in 2021 regarding the use of combination birth control for menstrual/ovulation suppression in women who are anticoagulated. (For Elise 😊)

A great podcast topic recommendation/suggestion: anticoagulation bridge therapy, and patients undergoing gynecological surgery. More to come…

In January 2022, the American Heart Association conducted a study and concluded that labetalol may be the best antihypertensive medication antepartum. However, the ACOG has not endorsed one antihypertensive medication over the other. But what about Postpartum? Is labetalol the best to prevent postpartum hypertensive readmissions? In this episode we will review a new publication being released October 2022 from Obstetrics and Gynecology (Green Journal). Which medication is best to prevent postpartum hypertensive readmissions? Listen and find out.

This message is for Dr. Rob in Northern California preparing for his OBGYN oral boards. Rob, thank you for your voice memo on the app! Great question and absolutely fantastic clinical insights. With that kind of clinical inquiry and drive, I am sure you will ACE your upcoming OB/GYN oral boards. Dr. Rob’s question is which progesterone would be best for treatment of abnormal uterine bleeding: a progestational agent or one that is more androgenic. Listen and find out.

Current ACOG/SMFM/CDC guidelines for the prevention of Group B Strep neonatal infection are aimed at prevention of early onset GBS neonatal disease. But late onset infections still occur worldwide and are devastating for the newborn. This is why there is a new Group B Strep (GBS6) vaccine in the pipeline! On September 22, 2022 the FDA granted this vaccine “Breakthrough Therapy designation”. In this session, we will review what that designation means, why this vaccine is needed, and where we are in the process.

Acetaminophen (Paracetamol) is the most common medication used in pregnancy. For several years now, observational studies have raised concern for use of this common OTC medication in pregnancy and autism spectrum disorder/attention deficit disorder in children. Does acetaminophen cause these neurodevelopmental disorders? In this session we will highlight 3 recent publications that have gained national and international attention. We will also summarize the statements from the FDA, ACOG, SMFM, and the SOGC.

There is a current trend advocating for women to do complete “hormone panels” for wellness. There is also persistent confusion surrounding the use of “bioidentical hormones” stemming mainly from the vast options of OTC and compounded “natural” hormone supplements. For women, compounded bioidentical hormones (cBHT) mainly takes the form of testosterone supplements/pellets. With decades of use of these products, what is the current state of opinion on them? In this episode we will review updated position statements for bioidentical hormone use from the National Academy of Science & Medicine, the NAMS, the ASRM, and the International Society of Sexual Health. We will discuss the use of “pan- hormone testing” and will also review when serum testosterone levels may be indicated and summarize key concepts for testosterone use in women.

Maternal mortality in the United States is among the highest of all industrialized nations. Shockingly, the top cause of obstetric death no longer belongs to pregnancy related factors; homicide is the most common cause of pregnancy associated death. And suicide is not far behind. In this episode we will review a new publication from the ACOG reviewing staggering statistics on pregnancy associated deaths. We will distinguish between “pregnancy related deaths” and “pregnancy associated deaths”, and discuss how “the big 4” are risk factors for both homicide and suicide.

Neonatal herpes infection can be devastating to the newborn. For patients with a history of known genital herpes, daily suppression beginning at 36 weeks until delivery has been the standard for over 2 decades. For the HSV2 negative pregnant patient with a HSV2 positive partner, is PREP an option? In this session, we were review management of the HSV2 discordant couple during pregnancy.

Gentian Violet has been used for over a century for a variety of conditions including vaginal candidiasis. Does it work? More importantly… is it safe? In this session we will review the medical history, current use of, and safety profile of Gentian Violet. We will discuss ACOG’s stance on ordering vaginal medications WITHOUT an examination and we will also cover the most recent antifungal medication which has been FDA approved, Brexafemme.