Dr. Chapa’s Clinical Pearls.

• Vag E2 in Women With CVA HX?

  Stroke (CVA) is very common in women, who have a higher risk than men over their lifetime; one in five women between the ages of 55 and 75 will experience a stroke. Stroke is a significant concern for women's health, being the third leading cause of death and causing more deaths than breast cancer. While systematic estrogen containing menopausal HT has been considered contraindicated in those with prior CVA history, is local/vaginal E2 therapy safe? A new population-based study gives us some insights. Listen in for details.1. Recurrent Ischemic Stroke and Vaginal Estradiol in Women With Prior Ischemic Stroke: A Nationwide Nested Case-Control Study; https://www.ahajournals.org/doi/10.1161/STROKEAHA.125.0509862. NAMS 2022 Position Statement; chrome-https://menopause.org/wp-content/uploads/professional/nams-2022-hormone-therapy-position-statement.pdf3. Stroke News & Brain Health | Published: August 21, 2025; https://newsroom.heart.org/news/vaginal-estrogen-tablets-may-be-safe-for-postmenopausal-women-who-have-had-a-stroke4. https://www.obgproject.com/2022/11/21/north-american-menopause-society-releases-2017-hormone-therapy-statement/5. https://www.goredforwomen.org/en/know-your-risk/risk-factors/risk-of-stroke-in-women-infographic#:~:text=Stroke%20in%20U.S.%20Women%20by,risk%20decreases%20in%20women%20who:

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• Does Vit B6 Reduce Mastalgia? New Meta-analysis 09/2025

  Mastalgia is a common breast complaint in reproductive aged women. Mastalgia can be separated into three categories: 1) cyclical, 2) noncyclical, and 3) extramammary. Vitamin B6 is often cited as a homeopathic (non-prescription/pharmacological) remedy for simple mastalgia. Does the published data support its use? A newly published meta-analysis sheds light on the subject.1. Sharifipour, F., Siahkal, S.F. & Bagherinia, M. The effectiveness of vitamin B6 in reducing mastalgia: a systematic review and meta-analysis. BMC Women's Health 25, 421 (2025). https://doi.org/10.1186/s12905-025-03991-x2. ACOG PB 164; reaffirmed 2023

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• 09.10.2025

  We are delaying today's program, as stated in this message. We will resume our program as soon as possible. Remembering Charlie Kirk.

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• Eric's Encounters: Suppl. to Our Prior Episode

  We have a wonderful podacst community! Within 24 hours of our immediate past episode release, one close friend- and fellow OBGYN, Dr. Eric Colton (OB Hospitalist Group) reached out and shared valuable words of wisdom regarding a potentially deadly complication of the CS-scar defect...the CS scar ectopic pregnancy. Listen in for Dr. Colton's cameo and details. 1. Ban, Yanli MD, PhD; Shen, Jia MD; Wang, Xia MD; Zhang, Teng MD, PhD; Lu, Xuxu MD; Qu, Wenjie MD; Hao, Yiping MD; Mao, Zhonghao MD; Li, Shizhen MD; Tao, Guowei MD, PhD; Wang, Fang MD, PhD; Zhao, Ying MD, PhD; Zhang, Xiaolei MD, PhD; Zhang, Yuan MD, PhD; Zhang, Guiyu MD, PhD; Cui, Baoxia MD, PhD. Cesarean Scar Ectopic Pregnancy Clinical Classification System With Recommended Surgical Strategy. Obstetrics & Gynecology 141(5):p 927-936, May 2023. | DOI: 10.1097/AOG.0000000000005113

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• Decidua or No Decidua at CS Closure: "New" Sept 2025 Data

  On Sept 10, 2023, er released an episode titled, “CS Ut Closure: Decidua or No Decidua?”. We highlighted the importance of AVOIDING the decidua at hysterotomy closure at CS. Now, in Sept 2025, in Obstetrics and Gynecology (the Green Journal), there is a new systematic review and meta-analysis on this very topic. Does this new study CONFIRM or REFUTE what we explained 2 years ago? Listen in for details. 1. Sept 10, 2023 Chapa Clinical Pearls Podcast: CS Ut Closure: Decidua or No Decidua?2. Lino GM, Galvão PVM, da Silva MLF, Conrado GAM. Not Closing Compared With Closing the Endometrial Layer During Cesarean Delivery: A Systematic Review and Meta-analysis. Obstet Gynecol. 2025 Jun 12;146(3):e55-e63. doi: 10.1097/AOG.0000000000005974. PMID: 40505112.

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