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Dr. Chapa’s Clinical Pearls.
12 minutes | Sep 24, 2022
New GBS Vaccine? YES
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.
21 minutes | Sep 19, 2022
Acetaminophen + Pregnancy= Autism?
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.
26 minutes | Sep 14, 2022
cBHT/Testosterone For Women
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.
13 minutes | Sep 11, 2022
The #1 Killer in Pregnancy
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.
20 minutes | Sep 7, 2022
HSV Discordancy in Pregnancy
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.
24 minutes | Sep 3, 2022
The Purple Vagina: Is GV Safe?
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.
23 minutes | Aug 28, 2022
Does Progesterone Prevent Miscarriage?
Progesterone has long been hoped to be a remedy for 1st trimester pregnancy loss. Does progesterone help reduce miscarriage risk? The data is ever evolving. In this session we will review 2 landmark studies that helped answer this question (PROMISE, PRISM). We will also cover a 2020 Cochran systematic review that helped change the 2021 NICE practice guidelines on the subject. Lastly, we will also cover the latest data on this from May 2022 (ACOG ACM).
14 minutes | Aug 24, 2022
FAIL! Disappointing New Data on Vaginal Progesterone
Oh, the twisted love story of progesterone and pre-term birth! Ever since the Meis trial in 2003, we have been fascinated with the use of progesterone as a possible cure-all of all things preterm birth. But the data keeps piling in, with results just contrary to that. In this episode we will review the publication history of progesterone and it’s fight against PTB. We will also highlight a new publication from the AJOG coming out September 1, 2022 analyzing vaginal progesterone’s effectiveness against PTB. Does it work? Let’s find out.
19 minutes | Aug 20, 2022
White Classification: Still Relevant?
In 1949, Priscilla White published her landmark study on diabetes in pregnancy, launching the “White Classification”. This has been a staple of pre-pregnancy diabetes nomenclature since that time. However, despite its historical role in obstetrics, is this scale still relevant? In this episode we will review the history, definitions of, and proposed alternative nomenclature to the traditional White Classification.
15 minutes | Aug 17, 2022
Epilepsy and Women’s Care
Epilepsy/seizure disorders disproportionately affects women of reproductive age over men. The influence of sex hormones on seizure prevalence is well documented. As women’s healthcare providers, it’s vital for us to understand the influence of seizure disorders on women’s overall care. In this session, we will review important aspects regarding contraception and review the data on pregnancy outcomes in women with epilepsy.
22 minutes | Aug 14, 2022
There are so many things to go over with our pregnant patients especially at their initial intake visit. However, one thing that should not be left off that discussion list includes food items to avoid! Listeriosis during pregnancy can be devastating for the fetus. Are you familiar with the work up and CDC recommended treatment for this condition? In this episode we will present an easy to remember protocol for managing patients with a possible exposure to listeria monocytogenes.
2 minutes | Aug 11, 2022
I’ll let this episode title speak for itself… LOL. Hope this makes you smile.
15 minutes | Aug 8, 2022
New Med for ENDO! (With Guest Co-Host)
Endometriosis is a devastating condition. Once thought to have its impact only during reproductive age, endometriosis has been linked to an increased risk of stroke later in life. Any new medication which shows safety and efficacy in menstrual pain reduction is welcome in this space. In this session we will review a new FDA approval of an existing medication in the battle against endometriosis. (Special guest co-host, Kacie Mitchell, 3rd medical student)
12 minutes | Aug 2, 2022
Mag Neuroprotection at 22 Weeks?
Yesterday, 08/01/2022, we released a podcast on “The 22 Week Birth”. As a follow-up to this, and in response to 5 separate questions (all related to the use of magnesium sulfate for fetal neuroprotection) from podcast members, we decided to get this episode out! While we all understand the upper limit for magnesium sulfate for CNS protection to be 32 weeks and 0 days, is magnesium sulfate a consideration at 22 weeks? We will lay out the timeline of data from 2017 to current day in this session.
21 minutes | Aug 2, 2022
The 22 Week Birth
Over the last several years, the “limit of viability” for neonates has decreased dramatically. The new “lower limit” of neonatal viability can now be considered to be as early as 22 gestational weeks. But there’s a lot more to that statement! In this session, we will review the latest data on neonatal survival in the Periviable interval. We will highlight and summarize a new publication from the Lancet published on July 25, 2022. Should we be performing “universal resuscitation” at 22 weeks? Or should we take a more “selective” approach? Let’s summarize the latest data.
14 minutes | Jul 28, 2022
Polyhydramnios affects from 0.2 to 2% of all pregnancies. Which is preferred for diagnosis, MVP or AFI? Is amnioreduction an effective intervention? When is indomethacin indicated? In the session we will dive into the issue of polyhydramnios, its workup, and delivery implications.
12 minutes | Jul 23, 2022
Misuse of Fetal Scalp Stimulation
One of the most common techniques to assess fetal status intrapartum is the fetal scalp stimulation test. First proposed in 1936, its incorporation in modern obstetric practice is still evident. However, there are some common misapplications and misunderstandings of this intervention. Does fetal scalp stimulation help resolve a fetal deceleration? Or could it be potentially harmful? In this podcast we will set the record straight to prevent misuse of the fetal scalp stimulation test. Thank you Abby for the podcast topic and bringing this to my attention.
15 minutes | Jul 19, 2022
HT in BRCA Patients?
In this session, we will continue our brief summary of the NAMS 2022 clinical update on hormone therapy. Is hormone therapy allowed in patients with known BRCA genetic mutations? Is Bazedoxifene safe? What about vaginal estrogen therapy? We will answer these questions and more in this session.
22 minutes | Jul 16, 2022
Can HT continue past 65? NAMS 2022 UPDATE
Medical information moves fast. We know a lot more about risks and benefits of hormone therapy since the impactful WHI study was first released. In this session we will review important new concepts from the NAMS Hormone Therapy update just released Summer of 2022. Is it safe to continue hormone therapy beyond the age of 65? Is “lowest dose for shortest duration” still a valid concept? We will tackle this question and more in this session!
13 minutes | Jul 12, 2022
New Data on Water Births (July 2022)
For several years, data has validated the value of water immersion during labor (1st stage). However, when it comes to the 2nd stage of labor, the AAP and the ACOG are unified in their positions which is at odds with the ACNM. But what does the new data support? In this session we will cover a new systematic review and meta-analysis from BMJ Open which was published July 2022. Let’s set the record straight on water immersion during the first and second stages of labor.
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