Dr. Chapa’s OBGYN Clinical Pearls

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The CDC confirmed in a report recently released that about 700 women die each year in the United States from cardiovascular conditions, infections, hemorrhages and other complications related to their pregnancies — up to a year after delivering their babies. In about 60% of the cases, the deaths could have been prevented, in part, with proper medical intervention, better access to care, and early recognition of risk factors/signs. The leading cause of death is CV conditions, such as heart disease and stroke, which accounts for 33% of pregnancy-related deaths. Infections account for nearly 13%, and obstetric hemorrhage accounts for 11%. In this session, we will review the ACOG practice bulletin (#212) as well as the CDC recent report on maternal mortality and cardiovascular disease.

Controversy surrounding screening mammography guidelines has resulted in conflicting recommendations from physicians and uncertainty for women. The Am Society of Breast Surgeons has released detailed/conservative screening recommendations for both average and high risk women. In this session, we will review their updated recommendations. We will also briefly review the following 4 supplemental screening modalities: 1. Contrast-enhanced Breast Magnetic Resonance Imaging (MRI), 2. Ultrasound, 3. Molecular Breast Imaging (MBI), and 4. Contrast-enhanced Mammography (CEM). (A summary table of screening recs can be found on our Facebook page).

In this session (Part 2), we will cover skin to skin neonatal contact at time of Cesarean birth. Is this possible? What does the data show? This will wrap up our two-part series.

Skin to Skin neonatal contact is endorsed/recommended by the AAP, AWHONN, the CDCP, and the WHO. What’s the data behind his practice? Are there any potential risks or safety concerns? And… What about C-Section deliveries? In this episode (PART 1) we will provide an introductory overview and discuss the data behind neonatal, post-birth, skin to skin contact.

Researchers estimate that approximately 10.2 million Americans have osteoporosis, and an additional 43 million have low bone density. Equally stark are the ramifications of these numbers. About 1 out of every 2 Caucasian women will experience an osteoporosis-related fracture at some point in their lifetime. In April 2019, the FDA approved a new dual action medication for osteoporosis therapy in postmenopausal women considered at high risk of fracture. This new medication is Evenity. In this episode, we will review the pathophysiology, diagnosis of, and treatment updates osteoporosis.

“Hysteria” referred to a constellation of psychological and physical ailments occurring only in women. It was thought to have its origin in the uterus. This can be traced back to ancient Egypt, the Greeks, and even the Roman era. Even the first FEMALE physician in Europe, Trota of Salerno (11th Century AD) propagated the theory. Ancient treatments for hysteria included “genital massage“ in order to release “unused materials” from the female body! Hence the origins of what persists today... the VIBRATOR.

Hey, we have all been there at one time or another: The ultrasound report shows an IUD/IUS in the endometrial cavity but it is NOT in the fundal location. What do we do? The answer lies mainly in the TYPE of IUD used! LNG-IUS devices seem to NOT be affected by low lying locations. The data on COPPER Ts, however, is still not clear....but risk of pregnancy is likely quite low. In this session, we will review the evidence regarding management of the non-fundal IUD.

What do Mexican Yams, menses, and the Pope have in common? The answer: the Birth Control Pill! In this session, we will review the interesting and slightly strange history of the oral contraceptive pill and the notion behind “withdrawal” monthly bleeding.

Both Androgen Insensitivity Syndrome (AIS) and Swyer Syndrone (Pure Gonadal Dysgenesis) are characterized by phenotypical females who are genetic males (46XY). However, The 2 conditions are very different pathogenically and have different clinical implications. For example, AIS patients can not become pregnant; however, Swyer patients may become pregnant after therapy. In this session, we will review the pathogenesis and clinical implications of these 2 46XY conditions.