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Dr. Chapa’s Clinical Pearls.

Dr. Chapa’s Clinical Pearls

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Relevant, evidence based, and practical information for medical students, residents, and practicing healthcare providers regarding all things women’s healthcare! This podcast is intended to be clinically relevant, engaging, and FUN, because medical education should NOT be boring! Welcome...to Clinical Pearls.
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This podcast focuses on the single most powerful tool each one of us possesses which ultimately determines our life outcome: our mindset. Our life is guided by our thoughts and attitude. We are the sum total of our thoughts, which govern all our decisions- consciously or unconsciously. The famed and influential US philosopher William James (late 19th century) stated, "The greatest discovery of any generation is that a human can alter his life by altering his attitude.” Join me as we explore ...
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EVA is a Vid/Podcast about simplifying the Traditional African Method of Settling Disputes or Appropriate Dispute Resolution (ADR) to attract more users around the world to settle their disputes via Mediation, Arbitration, Collaborative Law, Negotiation, Conciliation and Early Neutral Evaluation. ADR is taken to cover appropriate methods to litigation. Recent research (Umegbolu 2021) depicts that ADR -Mediation is cheaper, faster more flexible than Litigation. Besides that, disputes or confl ...
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Artificial Intelligence (AI) has arrived. Machine Learningis a form of AI which is being investigated/used for improving maternal outcomes. The UK has already launched the TOMMY APP (through the RCOG) for use to reduce PTB and stillbirths in the UK. In this episode we will highlight a new systematic review which assessed Machine Learning’s ability …
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We all are aware that multiple adverse obstetrical outcomes have been linked to maternal obesity, such as stillbirth, preterm birth, NICUs admission, and congenital anomalies. But once delivery and hospital discharge occurs uneventfully, a new cohort study is raising the alarm for another possible adverse event up until the child’s first year of li…
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I was privileged to engage in a stimulating and thought-provoking podcast with Professor Maria R. Volpe, PhD, on Expert Views on ADR (EVA) Vid / Podcast Show. She is a professor of Sociology, Director of the Dispute Resolution Program at John Jay College of Criminal Justice - City University of New York, and Director of the CUNY Dispute Resolution …
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Our immediate past episode summarized a validation study of cell-free DNA (cfDNA) isolated from maternal plasma for fetal RBC genotyping in alloimmunized patients. And now, in this episode, we will highlight a BRAND NEW ACOG Clinical Practice Update on this very subject! YEP... we now have new ACOG guidance regarding using maternal derived cfDNA fo…
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In September 2022, a cell-free DNA assay using next-generation sequencing and quantitative counting tech for fetal antigen status determination became clinically available in the USA. This allowed maternal screening for fetal RBC genotypes for RH negative patients. This test was recognized by thre ACOG in March 2024 as one option to “triage” anti-D…
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First off, let’s all agree that everyone has a different STYLE of sexual intimacy, and that’s OK. Yep, we all understand that there's always been a lot of sexual act “diversity” in the world… and throughout history. But there is a more recent trend that has increased in popularity, some surveys attribute it to its representation in pornography, tha…
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Candida in women is being right? Afterall, vulvovaginal candidiasis during pregnancy is common. Candida species may be isolated from the vagina of 15 %-21% of nonpregnant women; this rate increases to 30% during pregnancy. While it is generally benign and isolated to the vagina clinically, some Candida species have the capacity to be troublemakers.…
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Biomarker testing has arrived in Obstetrics. Of course, we have been using some biomarkers for years, like PAMG1 (Amnisure) and AFP+ILGFBP1 (ROM Plus) for ROM evaluation. In May 2023, the FDA cleared Thermo Fisher Scientific's maternal serum biomarker test for prediction of preeclampsia with severe features in hospitalized patients (and we have a p…
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Published studies, including 2 large network meta-analyses, support the safety and efficacy of misoprostol (PG E1) when used for cervical ripening and labor induction. Based on cumulative data, misoprostol administered vaginally at doses of 50 μg has the highest probability of achieving vaginal delivery within 24 hours. Prostaglandin E2 also has pr…
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Tuberculosis (TB) was historically called "consumption" due to the dramatic weight loss and wasting away experienced by patients. The modern name "tuberculosis" was first published by J. L. Schönlein in 1832. Today, between 3% and 5% of the U.S. population are estimated to be living with latent TB infection. Contrast that with the worldwide statist…
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Approximately 0.5% of all births occur before the 3rd trimester of pregnancy, and very early deliveries result in the majority of neonatal deaths and more than 40% of infant deaths. Preterm prelabor rupture of membranes (PPROM) is a known risk factor for preterm birth and is responsible for 30–40% of preterm deliveries. While PROM occurs around 8% …
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Researchers estimate that more than 100 million women in over 120 countries use tampons during their menstrual cycle. Tampons are generally considered safe and healthy menstrual products. However, a new study conducted by researchers at the UC Berkeley School of Public Health has identified the presence of 16 different heavy metals in tampons from …
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It's Summer…and its getting HOT in here! Although the effect of heatwaves in pregnancy has been studied various times, the data remains limited because these studies are observational, with very heterogenous populations, so its hard to prove causation between heat exposure and adverse outcomes. Nonetheless, these associations are indeed concerning.…
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Up to 1 in 10 reproductive-aged women are impacted by endometriosis. Dysmenorrhea is the most common pelvic complaint of adolescents. While most cases of primary dysmenorrhea in adolescents will be primary dysmenorrhea, Endo remains a possibility especially after 2-3 years of progressive symptoms. Although the true prevalence of endometriosis in ad…
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Well, sometimes the "traditional", evidence-based recommendations don't have the desired result they are supposed to. When the "usual and standard" ways of doing things fail, its time for "shared-decision making"! In this episode, we will highlight, and give KUDDOS, to an OB care team who exampled thinking outside-the-box in order to care for an ac…
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RSV season is just around the corner (Fall and Winter months). Newborns are 16x more likely to be hospitalized with serious RSV lung infection than the flu. On August 21, 2023, the FDA approved the first RSV vaccine, Abrysvo, for use in pregnant individuals to protect newborns and infants against severe RSV disease in the first 6 months after birth…
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I was privileged to engage in a stimulating and thought-provoking podcast session with Ellie Vilendrer on Expert Views on ADR (EVA) Vid /Podcast Show. She is the Co-Chair of the Early Dispute Resolution (EDR) committee (2020-2024) of the American Bar Association (ABA) Dispute Resolution Section and Vice Chair of the Orange County Bar Association Le…
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A substantial collection of evidence indicates that the fallopian tube serves as the primary site of origin for a large portion of high-grade serous ovarian cancers. As a result, clinical practice guidelines (including from the ACOG) recommend salpingectomy for permanent contraception- when necessary- rather than simple tubal ligation. But an Augus…
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Approximately 20% to 25% of pregnancies end in miscarriage, and there are many medical reasons why it may occur. About half are caused by chromosome aneuploidy. However, less than 5% of women will experience a second first trimester loss, and less than 1% will experience three early losses. The incidence of early spontaneous pregnancy loss increase…
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Happy Independence Day, America! We hope you are enjoying this wonderful, national holiday. Yep...Its a PARTY in the USA! In light of the festivities, here's a clinical question for us: Do fireworks affect the fetus? Even broader than that, do loud sounds in general affect the developing child? The answer is both YES and NO. Listen in to this short…
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(Here’s a WONDERFUL QI Project for this New Residency Academic Year) With 70.8% of pregnancies among adolescents being unintended, there is a clear need for increased access to contraceptive services. Many adolescents use the emergency department (ED) as their primary healthcare source, highlighting the importance of providing comprehensive sexual …
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PROM occurs in approximately 10% of pregnancies and leads to a risk of IAI in women that is 3 times higher than that in non-PROM women. The risk of early-onset sepsis of neonates born to mothers exposed to PROM is 20 times higher than in non-PROM mothers. An increasing time period with PROM increases the risk of infection for both mothers and newbo…
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Podcast Family, I hope this episode gives you pause and brightens your day 🌞. Just a quick work and acknowledgement to likley our YOUNGEST podcast family member and his mother, a Co-OBGYN preparing for oral Boards. 👏👏 Let this speak to you as the message spoke to me! (and introducing ​callmestevieray & Connor Price, whose words/song- “GRATEFUL”- al…
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Oral Hormonal contraception gets the blame for a lot ofthings, including the development of hypothyroidism. Hypothyroidism is one of the most common endocrine disorders affecting 5 to 10 times more women thanmen, and its prevalence increases with age. This association of OCPs with hypothyroidism comes from a controversial article in BMJ published i…
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I was privileged to engage in a stimulating and thought-provoking podcast session with Ijeoma Ononogbu on Expert Views on ADR (EVA) Vid /Podcast Show. Ms Ononogbu has over fifteen (15) years of international legal experience from working with international law firms in London as a solicitor, specialising in commercial transactions and ADR processes…
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Podcast Fam, on March 27, 2024 our episode was called "Balloon for PROM: Yea or Nay". Although mechanical cervical balloons for induction were the focus, we also discussed which medication is better (based on published data) for labor induction after PROM. Well, in this episode, we pick up from March with ANOTHER NEW STUDY released today (June 25, …
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Anxiety disorders are the most common mental health issue in the United States, affecting nearly 1 in 5 adults, or 40 million people. Another 19 million adults – 8% of the population – has depression. Prenatal mood disturbances are known to affect the fetal brain, and endocrine system. Left amygdalar volumes were smaller in newborns whose mothers h…
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Respect for patient autonomy is a fundamental part of the clinician-patient relationship and discussion of healthcare interventions. Some patients decline transfusion of blood products, either for religious or non-religious reasons, but most frequently as part of the Jehovah’s Witness faith. Acceptance of, and decision-making, surrounding blood pro…
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"HSDD" as a diagnosis has been gone for some time. According to the ACOG, the DSM-V defines the combined entity of female sexual interest/arousal disorder as a complete lack of or a substantial decrease in at least three of the following symptoms for at least six months: interest in sexual activity and sexual or erotic thoughts or fantasies. This i…
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Hypertensive disorders of pregnancy (HDP), including chronic hypertension, gestational hypertension, and pre-eclampsia, are increasingly common in the United States, complicating close to 15% of births, and the incidence is continuing to rise! On this show we have addressed medical management of urgent hypertension in pregnancy and in the immediate…
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At time of post cesarean discharge, most providers prescribe a fixed number of opioid tablets. However, past data has shown that most patients don't use all the opioids they are prescribed. This leads to an excess of opioids in the community, which can ultimately lead to misuse and diversion. In this episode, we will highlight a new publication fro…
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During my time in Hamtramck, I had the privilege of participating in a stimulating and thought-provoking podcast with Dwydell Garrett, the son of Sarah Sims Garrett. He shared with me the details of a landmark case that lasted over five (5) decades, from 1968 to 2024 - the case of Sarah Sims Garrett et al. v City of Hamtramck. The case has far-reac…
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Podcast Family, this episode has 2 parts: 1. First, a "non-medical" little life lesson that I heard recently which I will share with you...I hope it ENCOURAGES you, and 2. The MEDICAL part, which comes from Paul- one of our podcast family members. Paul had a GREAT question regarding the data covered in our immediate PAST episode on TOLAC....listen …
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After a primary CS, the decision to undergo trial of labor after cesarean (TOLAC) or schedule a repeat cesarean birth is one in which a patient’s values and preferences should be prioritized in a process of shared decision making. Some clinicians elect to utilize a TOLAC calculator as part of the shared decision-making process, while others use a m…
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Hemorrhagic disease of the newborn (HDNB) was first identified over a century ago, and presents as unexpected bleeding, often with gastrointestinal hemorrhage, ecchymosis and, in many cases, intracranial hemorrhage. In newborns, HDNB is typically caused by vitamin K deficiency as neonates are innately deficient in vitamin K secondary to very little…
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Proving that our podcast tagline, “Medicine Moves Fast” is true… this episode highlights something that is, once again, 🔥🔥🔥 Off the Press! on June 4, 2024, the ACOG released a new Practice Update regarding the determination of paternal and fetal RBC genotyping in pregnancies affected by alloimmunization. This builds upon and updates PB #192 from 20…
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June is CMV awareness month. And that’s the keyword there… Awareness! The way we prevent CMV transmission is by awareness. It would be great to have a vaccine against this virus, but we just don’t…yet. Until a safe and effective CMV vaccine is clinically available, primary prevention of cCMV relies on patient education and hygiene measures. In this…
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In 2011, Congress passed a resolution naming June "National CMV Awareness Month," to raise awareness about the most common congenital infection in the US, affecting 1 of 200 live births. It is the leading VIRAL cause of IUFD & miscarriage & the leading cause of neonatal hearing loss, second only to genetic causes. Furthermore, cCMV is more common t…
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I was privileged to engage in a stimulating and thought-provoking podcast with Alec Chapa on Expert Views on ADR (EVA) Vid / Podcast Show. Alec is committed to helping groups of people work together more collaboratively, transparently, and effectively. An accomplished mediator, conflict resolution practitioner, and published researcher, he has work…
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(VACAY EDITION) Recently in our high-risk OB clinic, I saw a patient who was disappointed that she “had to stop breastfeeding” as she entered her 3rd trimester with her 2nd child. Her first pregnancy was via vaginal birth, at term, with no complications. This situation is not frequently addressed and is a clinical dilemma. First, when nursing coinc…
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In our podcast archive, we have an episode titled, “TikToc’s #IUD is Killing a Good LARC”. In that episode, I discussed our protocol of using viscous lidocaine applied topically to the cervix, cervical canal, and coating the IUD device for placement. This works! In this episode, we will build on that concept by reviewing a publication released on M…
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It definitely is interesting how published data tends to have sporadic “groupings” in print. For example, last week 2 publications were released which could be placed under one “group”: prediction/prevention of spontaneous preterm birth. One publication (AJOG MFM) presented a systematic review and meta-analysis on universal cervical length screenin…
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It’s exciting to know that we are practicing a type of medicine that is alive and ever-evolving! Such is the case regarding our clinical practice/management of gestational diabetes. In this episode, we will review brand new (as of May 21, 2024) clinical guidance from the ACOG regarding gestational diabetes. Should we be screening for diabetes befor…
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The United States began adding fluoride to community water supplies in 1945. At that time, Grand Rapids, Michigan became the first community in the world to add fluoride to tapwater. Over the last several years, with an increase in reporting and media stories over the last 3 months, fluorinated drinking water has come under scrutiny and controversy…
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Podcast family, this episode is recorded on the last day of the ACOG ACSM. Wanted to share with you some encouragement that I received from our podcast family members over these last 2 to 3 days. AND of course, in typical style, I’ll share with you a brand new publication which was released on May 17, 2024 in the AJOG (GRAY Journal) regarding “opti…
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We all can agree that we need a new ally against the foe of pre-term birth. With the disappointing results regarding the (lack of) efficacy of progesterone in reducing preterm birth, the search is out for a new, effective tool to reduce pre-term birth rates. Enter: the Lioness(tm) device. In this episode, we will review a new “safety and efficacy” …
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Unbelievable timing! In our immediate past episode, we discussed the controversy surrounding pharmacoprophylaxis for antepartum inpatients. Just 3 days from that episode, a new RCT has been published in the Green Journal (Obstet Gynecol) discussing this very subject! This new RCT (published May 14, 2024) investigates the “best dose” of unfractionat…
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All of us can agree that the rates of obesity are progressively climbing, not just in the US, but globally. Obesity is a known independent risk factor in pregnancy for VTE. Several professional societies (ACOG, CMQCC, RCOG, SMFM) have clear recommendations for VTE pharmacoprophylaxis in patients considered at high risk. These include having a high …
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Bacterial vaginosis (BV) is known as a normal vaginal microbiota resulting in low lactobacilli; it affects one-quarter to one-third of reproductive-age women. The BV treatment landscape has not appreciably changed in decades: in the US, metronidazole and clindamycin are recommended as first-line treatments for symptomatic BV, and secnidazole and ti…
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I was privileged to engage in a stimulating and thought-provoking podcast with Professor Sharon Press on Expert Views on ADR (EVA) Vid / Podcast Show. She is the Director of the Mitchell Hamline School of Law Dispute Resolution Institute (DRI). She teaches Mediation and Negotiation (in both online and in-person formats).Professor Sharon is the Co-P…
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