Dr. Chapa’s OBGYN Clinical Pearls

The United States, along with Mexico and the Philippines, was ranked one of the world's worst places for human trafficking in 2018. In the US, there is no official number of human trafficking victims, but estimates place it in the hundreds of thousands. From illicit massage parlors, escort services, online pornography, and adult “dating” sites, women make up the majority of sex trafficked victims. In this session, we will review the ACOG committee opinion from September 2019, as well as review data from the US Homeland Security Bureau of statistics.

Ahhh...Oooh! The elusive G-Spot! First described in the 1950s by gynecologist Ernst Grafenberg, the “G-Spot” has been a “hot topic“ in sexual wellness circles. But does this exist? Is there a real “magic button“ for intense, female pleasure? New understandings of the relationship between the clitoris and anterior vaginal wall has resulted in a better name for this SPOT: The “Clitoral Urethral Vagina Complex" or "CUV." Let’s talk about that...now. {IMAGE/DIAGRAM on our Facebook page.}

Approximately 45% of pregnancies in the United States are unintended. Similarly, 70% of pregnancies that occur within 1 year of delivery are also unplanned. Interpregnancy interval shorter than 6 months are associated with increased risk of perinatal complications. In this session, we will review the stance from the ACOG and the SMFM regarding immediate postpartum LARC initiation. What is the difference between “immediate” placement and “early postpartum“ placement? Are there any risks? We will cover these topics and more in this episode.

Preterm birth is now the 2nd leading cause of death in children under 5 years worldwide and accounts for half of all newborn deaths, according to the March of Dimes and the World Health Organization (WHO). Besides progesterone, does DHA have a role in reducing preterm birth risk? In this session, we will summarize recent data regarding “fish oil” supplements and preterm birth risk. We will also describe a new proposed “DHA maternal blood test” which may help identify women who would benefit the most from DHA supplementation.

In our previous episode, we covered the revised FIGO ovarian cancer staging which now includes fallopian tube and peritoneal malignancies. In this episode, we will cover the FIGO guidelines regarding the management of OVFTP cancer. What role do PARP inhibitors play? Does treatment for asymptotic recurrence based on CA125 help? Can tamoxifen be used in recurrent malignancy? Let’s find out… Now.

The lifetime risk of a woman in the USA developing ovarian cancer is approximately 1 in 70. Malignant tumors of the ovaries occur at all ages with variation in histologic subtype by age. For example, in women younger than 20 years of age, germ cell tumors predominate, while borderline tumors typically occur in women in their 30s and 40s—10 or more years younger than in women with invasive epithelial ovarian cancers, which mostly occur after the age of 50. About 23% of gyn cancers are ovarian, but 47% of all deaths from cancer of the female genital tract occur in women with ovarian cancer. In this podcast we will summarize the new FIGO classification system for ovarian cancer which now includes malignancies of the fallopian tube and peritoneum (OVFTP).

Dive into the complexities of adjuvant therapy for endometrial carcinoma. Discover the pivotal roles of radiation and chemotherapy in treatment regimens. Learn whether progestin therapy is a viable option. The discussion wraps up with a chilling look at the implications of discovering endometrial cancer after a hysterectomy meant for benign conditions. It's a rollercoaster of insights aimed at navigating some challenging scenarios in gynecological oncology.

Endometrial carcinoma, the most prevalent gynecological cancer, often presents with abnormal vaginal bleeding, particularly in postmenopausal women. The 2018 FIGO guidelines shed light on crucial risk factors like obesity and estrogen levels. Insights into the differences between type 1 and type 2 cancers are explored, alongside the importance of surgical staging and preoperative assessments. The discussion also emphasizes lymphovascular space invasion and its pivotal role in prognosis, laying the groundwork for subsequent treatment options.

In this Part 2, we will review the pathological reports which may influence cervical cancer clinical staging. We will also summarize the 2018 FIGO treatment guidelines. In brief: For stage 1A1-1B1: surgery is recommended; Stage 1B2-IIA1: surgery or radiation may be used; Stage 1B3-IVA: concurrent chemoradiation is standard; Stage IVA may need an exenteration; and Stage IVA is managed with chemoradiation.

Recent developments in imaging and increased use of minimally invasive surgery have changed the paradigm for diagnosis and management of cervical cancer. The FIGO Gynecologic Oncology Committee, in 2018, revised the Cervical Ca staging system based on these advances. Imaging evaluation may now be used in addition to clinical examination where resources permit. The revised staging permits the use of any of the imaging modalities according to available resources, i.e. ultrasound, CT, MRI, positron emission tomography (PET), to provide information on tumor size, nodal status, and local or systemic spread. In this session, which is Part 1, we will review the pathogenesis, epidemiology, symptomatology, and 2018 FIGO revised cervical cancer staging system. We will leave management of cervical cancer for Part 2.