Dr. Chapa’s OBGYN Clinical Pearls

The etonogestrel implant is the most effective LARC available. Well, how many years AFTER the FDA approval of 3 years does the implant remain effective? Also, currently, the usual and customary standard is for the provider and patient to palpate the implant area after insertion. But what happens when the insert is non-palpable? In the session, we will review the evidence-based protocol to find this nonpalpable implant. Can you order a serum etonogestrel level? Do these things “migrate”? Can a patient still use it for birth control after 3 years? Listen in, and find out.

Historically, obstetrical providers cautioned patients about decreased fetal movement. But what about maternal perception of INCREASED fetal movement? Is increased fetal movement a harbinger of adverse neonatal outcome? In this session we will highlight and summarize a new publication from the AJOG (April 26, 2022) that helps shed light on this clinical conundrum.

Since the 1960s, metronidazole has carried a label warning stating that alcohol use while taking the medication can lead to significant side-effects. This was termed a “Disulfurim-like reaction”. However, that’s 100% not true! Where did this metronadazole myth come from? Why has it survived for over 50 years? In this podcast… We’ll set the record straight! Yes, you can have your cake and eat it too… I mean, your beer and drink it too! 🍻🍺🍻🍺🍷🍷🍷

On May 3, 2022, JAMA published 2 separate randomized clinical trials (RCTs) regarding patient’s self-monitoring of blood pressures at home. Historically, clinicians instructed patients either at risk of developing hypertension in pregnancy or those with existing chronic hypertension/hypertensive disorders in pregnancy to self-monitor their blood pressure in-between clinician visits. Is that recommendation clinically useful? Does the data support that? Once again, the world of “hypertension in pregnancy” is being shaken up! In this podcast we will review these 2 recent RCT studies which may the change the way we practice obstetrics.

In May 2022, the ACOG Will release a new Clinical Practice Guidance (#3). This will cover “Headaches in Pregnancy and Postpartum”. Do you know which classes of medication are considered first line for primary headache prevention during pregnancy? And for acute treatment of migraine, which medications are recommended? Are Ergot alkaloids safe for use? What about Triptans? In this session, we will summarize and highlight Clinical Pearls for the prevention and treatment of primary headache in pregnancy and during lactation.

Addressing severe maternal morbidity is a public health priority in the US. Postpartum hemorrhage is one of the driving contributors to severe maternal morbidity/mortality peri-partum. A recent study published in JAMA open network in February 2022 is showing an unusual benefit of labor epidural analgesia which may help close the gap in severe maternal morbidity-related healthcare disparities. In this episode, we will highlight the key findings of this publication and review “epidural’s secret benefit”.

It could not have been timed any better: Coming off the heels of the recent FDA warning on the use of noninvasive prenatal test (NIPTS), a new study soon to be released in May 2022 is calling its use into further question. Is this a return of the Maternal Serum QUAD screen? Listen in and find out.

On April 19, 2022 the FDA released a warning regarding the inappropriate use of cell free DNA genetic screening tests. Within 24 hours, the ACOG (April 20, 2022) issued a statement response. In this podcast we will highlight these two key documents. We will also review what cell free DNA is and is not. What is the role of Ultrasound in genetic screening? Can cell free DNA be repeated after a “no call” result? Lots of important information… Covered here!

Without doubt, the most common reason for requested progestin-intrauterine system (IUS) removal is abnormal bleeding patterns. But do you know what the second most common reason is? It’s acne! In this episode, we will summarize a soon to be released article accepted for print in Obstetrics and Gynecology (the Green Journal). This episode will provide practical clinical pearls to truly obtain informed consent from our patients seeking long acting reversible contraceptives (LARCS).

On Friday, April 15, 2022, I received a Facebook question regarding a recent episode on ROM test. We stated that ROM Plus, as a test, has accuracy between 23 to 37 weeks. Where does that come from? In this brief episode, will explain the facts.