Dr. Chapa’s Clinical Pearls.

Asthma is more prevalent in adult women than in adult men. Specifically, data from the National Health Interview Survey (NHIS) indicates that 9.7% of adult women had asthma, compared to 5.5% of adult men. This higher prevalence is observed across various racial and ethnic groups within the adult female population. At the end of April 2025, new population-level data was published (UK) describing an alarming association between progastrin only pills and asthma exacerbations. Is this a new finding? Recently, it seems that there has been a barrage of negative press towards progestin only contraceptives: depo provera and brain tumors, progestin releasing IUS and breast cancer, and the progestin IUS and rosacea. What is happening here?! We'll break it all down in this episode.

Female Genital Mutilation (FGR) is condemned by the WHO, Unicef, and the US. Nonetheless, it is still being performed worldwide, and in North America. In this episode, we will recently published data (April 2025) from BMC regarding this practice. This episode's topic was brought to me by one of our podcast family members who currently has a pregnant patient with FGR. Does this patient require a cesarean section? What are the 4 types (classifications) of FGR? Listen in for details.

(Topic Requested): Serum Magnesium and Calcium have an intimate and complex relationship best described as “love-hate”. One of our podcast family members sent me this fascinating question: “Should we be following serum calcium levels in patients undergoing IV Mag Sulfate use in obstetrics, in order to identify dangerous hypocalcemia?...Should we be giving these patients prophylactic calcium?” Thera are indeed published case reports of hypocalcemia induced tetany in patients. However, are there national guidelines which call for “calcium surveillance”? Do you remember what the Chvostek's and Trousseau's signs are? Listen in for details.

Some debates in medicine and in OBGYN are “the same ol’ thing”. Like the debate on when to remove the urinary catheter after a “routine” cesarean section. In the original 2019 ERAS publication, the authors stated that “immediate” removal of the urinary catheter was “strongly recommended”. This drew concern and criticism as being too early in the recovery process. Not, in the UPDATED ERAS guidelines (as of end of April 2025), this recommendation has once again changed! In this episode, we will review the new guidance from the ERAS Society regarding post cesarean section care focusing on when to stop IV fluids and urinary drainage.

The term "genitourinary syndrome of menopause" (GSM) was introduced in 2014 by the International Society for the Study of Women's Sexual Health and the North American Menopause Society (now the Menopause Society). This new term was created to replace older terms like vulvovaginal atrophy, urogenital atrophy, and atrophic vaginitis, and it encompasses the range of symptoms related to hormonal changes in the vulvovaginal and urinary tract areas that can occur during menopause. Recurrent UTIs are more likely in postmenopausal women not on vaginal estrogen therapy. IN this episode, we will highlight new data from the recent AUA meeting which looked at surprising benefits on postmenopausal vaginal estrogen in women with recurrent UTIs. Nonetheless, questions on the data remain. Listen in for details.

The ERAS (Enhanced Recovery After Surgery) concept was initially developed for colorectal surgery in 1997 to standardize surgical protocols. The ERAS Society then first published a guideline for cesarean section (ERAC) in 2018-2019. Now, as of April 28, 2025, the ERAS Society has released a NEW UPDATE for ERAS-CS. In this episode we will focus on 2 main areas: 1. Vaginal prep at CS, and 2.Extended antibiotic prophylaxis in patients with obesity! Medicine moves fast, and this data exemplifies that. PLUS, we will relate these 2 points back to the ACOG PB 199 which focused on prophylactic antibiotics at cesarean section.

I know this sounds braggadocious, but I'm going to say it anyway: I work with some incredible people! We recently released a podcast on updated TOLAC uterine rupture data. One of our former residents reached out to me with a question about this: “Did they include interdelivery interval in their assessment?” You see, I work with really smart people! There's an answer to that question, and we're going to cover that in this episode. PLUS, a current resident, Spencer, had a great question about proof of immunity to rubeola (measles) in pregnancy. Can we assume that if a patient is rubella immune that she is also immune to rubeola? That's a great question, and we will explain in this episode!

Spontaneous twin pregnancies occur in about 1 out of every 250 pregnancies. A real world clinical question has to do with dating a spontaneous twin gestation: Do we use the smaller crown rump length or the larger for dating in the 1st trimester? Do we use the smaller or larger measurement of biometry in the 2nd trimester? We had this discussion today in our prenatal clinic, and in true form and fashion, I turned it into an episode! PLUS, there is practice guidance from Jan 2025 (ISUOG) to settle the debate. Listen in for details.

In the ACOG Practice Bulletin 205 (Reaffirmed August 2025), the stated risk of uterine rupture with TOLAC is stated as 0.7% (after 1 prior LTCS). However, as our podcast tag list holds true, "Medicine Moves Fast". In an new upcoming publication from Obstet Gynecol (The Green Journal), May 2025, authors looked at the rate of uterine rupture with TOLAC over a 12 year interval. The rate of uterine rupture was NOT close to the national quoted rate in the Practice Bulletin. This information, which was also presented at the Jan-Feb 2025 Pregnancy Meeting, can be very helpful in counseling patients desiring TOLAC. Listen in for details.

As healthcare professions we are often pulled in different directions ALL AT ONCE. It happens. We "multitask" every day. Or do we? Neuroscience actually states that we don't multitask at all; rather, we "task-switch" and that may lead to increased physiologic and mental stress and patient error. Yep, there is a MYTH about multitasking. In this brief episode, we remind ourselves that its OK to put somethings off, as able, until one task is completed. As the famed stoic philosopher Publilius Syrus wrote, "To do two things at once is to do neither". Listen in for details.

I love my home state of TEXAS. I am definitely full of Texas pride. We have Texas barbecue, Texas, hospitality, and of course, the Texas music scene! Our state definitely has some issues to improve on, mainly access to maternity care. We have a HUGE state and 50% of our counties are maternity care deserts. It’s a vast vast Land to cover! Texas has also received a lot of criticism regarding its heartbeat law originally named SB8, which was passed in 2021. Commentaries since then have stated that OBGYNs are leaving the state by the droves! Is that accurate? A new publication from JAMA network open (April 21, 2025) seems to contradict these commentaries. Listen in for detail details.

There have been various publications and commentaries published on “evidence-based” cesarean section techniques. Still, one of the persistent controversies on abdominal wall closure relates to the rectus. With transverse fascial entries, should we close/reapproximate the rectus or not? In June 2025, a new RCT looking at this very issue will be printed in the European J Obstetrics Gynecology and Reproductive Biology. Listen in for details.

On December 13, 2022, we released an episode describing a new concept in prenatal care, called the PATH model. This was to “redesign” prenatal care, as needed, for those who may have limitations for the “traditional” model of prenatal care visits. Well, what we covered 2.5 years ago is NOW an OFFIICAL guidance from the ACOG and will be out in May 2025. Similarly, the SMFM released their vision for redesigned maternal care teams on 16 April 2025 (J Pregnancy). We will BRIEFLY summarize these 2 publications in this episode.

Pelvic congestion syndrome is a controversial entity that does not currently have validated diagnostic criteria. In the ACOG PB 218 (2020), it states, “Pelvic congestion syndrome is a proposed etiology of chronic pelvic pain related to pelvic venous insufficiency. Although venous congestion appears to be associated with chronic pelvic pain, evidence is insufficient to conclude that there is a cause-and-effect relationship. In addition, there is no consensus on the definition of this condition, and diagnostic criteria are variable. Further research is needed to establish greater consistency in diagnosis and homogeneity in treatment studies”. Is that it? Is that all there is? NO! There has been great interest in the diagnosis of this enigmatic condition and in potential new treatment options. The last publication on this was just released in March 2025 as a “pilot study”. In this episode, we will combine multiple sources and explain this controversial condition and offer hope to patients who may indeed have this real disorder.

On Monday April 7, 2025, the UK’s publication The Guardian wrote, “Surgeons are hailing an ‘astonishing’ medical breakthrough as a woman became the first in the UK to give birth after a womb transplant. Grace Davidson, 36, who was a teenager when diagnosed with a congenitally absent uterus, said she and her husband had been given ‘the greatest gift we could ever have asked for’. Grace’s sister donated her own womb during an eight-hour operation in 2023. Davidson said she felt shocked when she first held her daughter, who was born by planned NHS caesarean section on 27 February. She was first UK womb transplant recipient to give birth”. Since the first successful uterine transplant in 2011, there have been over 70 live births worldwide. These births have occurred following more than 100 uterine transplant procedures. This episode, we will review the fascinating history of this procedure. We will also answer some questions regarding uterine transplant like can the patient has vagina sex after this? How is this procedure done? Are these babies born vaginally? And which location in TEXAS become a world-renowned uterine transplant center? Listen in for details.

On March 19. 2025, The American College of Clinical Pharmacy published, "A review of antibiotic safety in pregnancy- 2025 Update". In this episode, we will review some of the confusion surrounding aminoglycosides, sulfa, and nitrofurantoin in pregnancy. Its interesting how different professions view certain medications in pregnancy. Does ACOG say you can use Sulfa in the third trimester? Can you use nitrofurantoin in the first trimester? Listen in for details. (SHOUT OUT to our partner podcast, CLINICAL PEARLS LATINO, for the topic idea. GRACIAS AMIGOS)

Well Podcast Family, in this VERY BRIEF episode, we will highlight a patient's perspective on IUS insertion with lidocaine jelly pre-insertion prep. As we have stated in past episodes, I am a BIG ADVOCATE of lidocaine jelly for IUD/IUS insertion. This patient agreed to share her experience of the EASY BREEZY IUS placement. (NOTE: HIPAA protected, patient agreed to participate in this episode).

Animal bites in humans are a common problem in the United States, with two to five million occurring each year. The vast majority of animal bites are caused by dogs (85 to 90 percent), with the remainder caused by cats (5 to 10 percent) and rodents (2 to 3 percent). Children are bitten more often than adults. The most feared complication of an animal bite is rabies, although skin infection is the most common complication. In our community high risk clinic, we recently saw a pregnant patient, who also has diabetes, who had a “cat bite” reported to our nursing staff. On examination, it was more like she was mauled by the cat! Both her feet had significant scratches and bite marks. Are you up to date in your animal bite care algorithm? It's one of those occurrances that are low frequency but have potential high morbidity. So in this episode I thought we would review the care plan for a patient who has suffered a cat bite, or animal bite in general. Meow Meow.

VVC is second to BV in vaginitis type, here in the USA. data indicate that 75% of women have experienced at least one episode of genital candida throughout their lives . VVC is currently classified as uncomplicated (sporadic infection with mild-to-moderate clinical symptoms in non-immunocompromised women) or complicated (recurrent or clinically severe infection that eventually affects immunocompromised women or is caused by non-Albican species). What is the best course of action for these patients? Topical therapy or oral? Single or multiple dosages? In this episode, we will highlight a new publication from the AJOG which was just released ahead of print that looks at this issue. PLUS, we will revisit a 2001 multicenter study on single Diflucan vs sequential dosing every 3 days. As a little bonus, as the AJOG new publication is Italian, we will have sporadic interludes from ITALIA's best! Listen in for details.

Postural Orthostatic Tachycardia Syndrome (POTS), first described in the 1940s, is a heterogeneous and often debilitating condition affecting the autonomic nervous system, estimated to affect between 0.3% and 1% of the U.S. population. Its incidence is believed to be rising among people with a prior COVID-19 infection, as a likely component of so-called long COVID. The condition is characterized by chronic orthostatic intolerance in the absence of orthostatic hypotension manifested as excessive increased heart rate upon standing. The etiology is not well understood but is thought to be complex. One recent publication described the complex etiology of POTS as, “A multitude of pathophysiologic mechanisms including but not limited to disproportionate sympathoexcitation, volume depletion, autoimmune dysfunction, cardiac and physical deconditioning point to a heterogeneously complex etiology”. Other POTS symptoms include fatigue, headaches, cognitive impairment, palpitations, chest pain and gastrointestinal symptoms. These symptoms can significantly reduce quality of life. Interestingly, most people with POTS are under age 50. In this episode we will review POTS in pregnancy. What therapies are available? Does anxiety have a role within this process? Listen in for details.