Podcast Summary: Dr. Chapa’s Clinical Pearls

Episode: Eric's Encounters: Supplement to Our Prior Episode

Date: September 6, 2025
Host: Dr. Chapa
Special Contributor: Dr. Eric Colton (OB Hospitalist)

Episode Overview

This brief, ad hoc episode supplements the previous episode’s discussion of uterine closure techniques during cesarean sections. Prompted by insights from Dr. Eric Colton, it specifically addresses the rarely discussed but potentially life-threatening complication of C-section scar ectopic pregnancies. Geared toward medical students, residents, and practitioners in women’s health, the episode combines evidence, clinical anecdotes, and a welcoming, conversational tone.

Key Discussion Points & Insights

1. Community and Podcast Goals

• Dr. Chapa opens by emphasizing the sense of community and family within the podcast team and listeners, aiming for improved care and reduced stress in practice.
  • "It really is a living community and we encourage and build up on each other...this is hoping to translate into better quality care so we don't get into situations that...are highly stressful because the life is stressful enough." (A, 01:14)

2. Trigger for the Episode: Scar Ectopic Pregnancies

• Dr. Chapa received a message from Dr. Eric Colton, OB Hospitalist Group leader, after the recent episode on decidua inclusion during C-section closure.
• Dr. Colton raised a critical complication not addressed in the systematic review: C-section scar ectopic pregnancies.

3. Clinical Relevance & Rarity

• Scar ectopic pregnancies are rare (1 in 1,800–2,000 C-sections), but can be life-threatening.
• Management is complex and varies: intralesional or systemic methotrexate (sometimes with balloon), uterine artery embolization, wedge resection, or even hysterectomy.
  • "We don't even know what the best therapy is for this, except that they have to be treated..." (A, 03:24)

4. Eric’s Clinical Experience (Cameo by Dr. Colton at 06:25)

• Dr. Colton recently managed two cases of C-section scar ectopic, sharing practical clinical insights:
  • "Do we incorporate the decidua in our hysterotomy closure at time of C-section or not? And it seems at this point in time the evidence is pointing to some benefit in not incorporating the decidua into your uterine closure." (D, 06:28)
• Early ultrasound findings can identify these ectopics:
  • A sac very low in the uterine cavity, bulging at the prior cesarean scar site, found in dating scans at ~6 weeks.
  • "You may see the gestational sac very low in the uterine cavity and possibly what appears to be like a bubble or a herniation in the anterior wall..." (D, 07:19)
• Urges the need for further evaluation, as these pregnancies risk early uterine rupture.

5. Literature Reference

• Brief mention of a May 2023 Green Journal publication that proposed a new clinical classification for C-section scar ectopics—though not discussed in depth.

6. Practical Pearls

• Encouragement to pay attention to ultrasound findings in patients with prior C-sections.
• Reinforcement that technique in hysterotomy closure may impact risk of scar defects and subsequent complications.

Notable Quotes & Memorable Moments

• On the Shakespearean Dilemma:

  • "It was very Shakespearean. To close or not to close a decidua." — Dr. Eric Colton’s message (A, 02:20)
  • “Shakespeare once said, to close or not to close. That is the question at time of C section okay, so it wasn't Shakespeare, but that's the question.” — Dr. Colton (D, 06:25)

• On the gravity of scar ectopic:

  • "One of the issues though that that article didn't address really was a life threatening issue that can happen with the C section. Niche defect...the potential life threatening issue?...Eric is right. He's talking about C section scar ectopics." — Dr. Chapa (A, 02:23)

• On Clinical Signs:

  • “There are very specific ultrasound findings that...increase the risk or the presence of this…around six weeks you may see the gestational sac very low in the uterine cavity...” — Dr. Colton (D, 07:07–07:23)

Timestamps for Key Segments

• Podcast Family & Community Introduction: 00:00–01:36
• Why This Supplement? The Message from Dr. Colton: 01:40–03:03
• Scar Ectopic: Description & Rarity: 03:04–05:23
• [Ad/Promo, skipped]: 05:24–06:25
• Dr. Colton's Clinical Perspective (Cameo): 06:25–07:57
• Closing Remarks & Team Appreciation: 07:57–End

Tone & Language

The episode maintains an upbeat, collegial, and conversational style. The hosts inject humor amid clinical seriousness, highlighting the joy and teamwork inherent to their podcast family.

Summary Takeaways

• Scar ectopic pregnancy is a rare but life-threatening consequence of C-section, closely tied to how the uterine incision is closed.
• Early, low-lying gestational sacs in women with prior C-sections should prompt concern and further work-up.
• Current evidence tends to favor not including the decidua in uterine closure at C-section to potentially reduce risk, though management of scar ectopics remains challenging and individualized.
• This short, unscheduled supplement exemplifies the podcast’s mission: rapidly translating real-world clinical pearls from the frontline to the broader OB/GYN community.

Best for: OB/GYNs, residents, medical students, and anyone wanting quick, relevant clinical pearls on C-sections and their complications.

“We are one big happy family here.” — Team Member (B, 01:36)
“It seems...the evidence is pointing to some benefit in not incorporating the decidua into your uterine closure.” — Dr. Colton (D, 06:29)

(Advertisements, intros, and outros have been omitted for clarity and relevance.)