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- [00:00]
A
Foreign. This is not, I repeat, not the time for our regular scheduled release. We just did an episode like less than 24 hours ago because we recorded our latest episode, which was a summary of a systematic review and meta analysis from the Green Journal on what whether or not to include the decidua at time of C section hysterotomy closure. Okay, we did that on September 5, 2025. So you gotta go back and listen to that. This is not a full episode, but it's a really nice supplement to that. And we're recording this less than 24 hours from that previous release. So today's date, just for record is September 6, 2025. Now, as I've said many, many times before, and I want you all to get this, this is why we've, we're that, you know, there's four people who helped me with this podcast and myself, so there's five on our little team. And I'm very thankful for what this, this team has built over the years. It really is a living community and we encourage and build up on, on each other. And ideally, you know, this is hoping to translate into better quality care so we don't get into situations that, you know, we're going to regret or are highly stressful because the life is stressful enough. All to say, our podcast community really is, has developed and morphed into this really nice little podcast family.
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B
Look, we are one big happy family here.
- [01:41]
A
So let me explain here how this whole thing happened. Okay, so you know, we did the episode and then on the morning of September 6, 2025, I received a text from a buddy of mine who, who is part of the leadership of OB hospitalist group, a phenomenal group. They do great things all throughout the country and making sure labor and delivery has, has quality physicians so that, you know, patients don't fall into a gap. So that's Dr. Colton. So Eric is a good friend and he sent me this message, said, hey, I just listened to the episode. It was very Shakespearean. To close or not to close a decidua. This was his message and said, you know, one of the issues though that, that that article didn't address really was a life threatening issue that can happen with the C section. Niche defect. Come on guys, what is he talking about? What is the potential life threatening issues? Not the intramenstrual bleeding, not potentially the pelvic pain that other studies have found and not this systematic review and meta analysis or the infertility. While that's devastating, it's not life threatening. And Eric Is right. He's talking about C section scar ectopics. Okay, now I'm gonna play. He's gonna get into you. I want him to tell you his experience and his take on this. Cause he just had recent experience with this. With not one, but two patients who actually had cesarean scleric topics and required specialized therapy. We don't even know what the. What the best therapy is for this, except that they have to be treated. Some have, you know, proposed intralesional methotrexate, systemic methotrexate with a balloon. Others have said, of course, just hysterectomy, which is devastating. Others have proposed potentially wedge resection as long as it's not close to the bladder dome. There's all these different ways to address this, including neuron artembolization, that are not easy. Okay, now, thankfully, cesarean SCARC topics are not common. We're talking about anywhere from 1 in 1800 to 1 in 2000, based on who you read. And not long ago, guys, in 2023, I think it was in May. Was that May? In May of 2023, in the green Journal, there was actually a proposal of a new clinical classification system for cesarean scoric topics. We're not getting into that. I don't want to get into all that, except to say yet another reason to avoid the decidua, as Eric very well stated. And I'm going to give you. He's going to give his little cameo here in a minute because I said, hey, Eric, you gotta. You gotta share this. Put this out there. So if you don't mind, send me. Send me this info as a voice memo and we'll put it into a little supplement. So I decided to call this Eric's Encounters as a supplement to our immediate recently released episodes. You got to go back and listen to that one where we cover the September 2025 new publication from the Green Journal. But I wanted Eric to give you his take on this. So now, without further ado, here's Eric. Tired of all the spin in women's health education. Yeah, so are we. This is Dr. Chapa's OBGYN no Spin podcast.
- [05:25]
C
Eczema isn't always obvious, but it's real. And so is the relief from EBGLIS. After an initial dosing phase, about 4 in 10 people taking EBGLIS achieved itch relief and clear or almost clear skin at 16 weeks. And most of those people maintain skin that's still more clear at one year.
- [05:42]
B
With monthly dosing, EBGLIS Librekizumab LBKZ a 250 milligram per 2 milliliter injection is a prescription medicine used to treat adults and children 12 years of age and older who weigh at least 88 pounds or 40 kilograms with moderate to severe eczema, also called atopic dermatitis, that is not well controlled with prescription therapies used on the skin or topicals or who cannot use topical therapies. EBGLIS can be used with or without topical corticosteroids. Don't use if you're allergic to Eglis. Allergic reactions can occur that can be severe. Eye problems can occur. Tell your doctor if you have new or worsening eye problems. You should not receive a live vaccine when treated with epglis. Before starting Epglis, tell your doctor if you have a parasitic infection searching for real relief?
- [06:17]
C
Ask your doctor about epgliss and visit epglis.lilly.com or call 1-800-LilyRx or 1-800-545-5979 as.
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D
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. 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. One of the obstetrical concerns with incorporating the decidua has been the findings of what has been referred to as an isthmocele and the embryo implanting low in the uterine segment in this incision increases the risk of of a C section scar Ectopic pregnancy There are very specific ultrasound findings that have been shown that increase the risk or the presence of this. One of which is noting early on in your ultrasound for dating purposes around six weeks is 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 where the C section scar is. This should be a key point in this finding with a patient with a previous C section for further evaluation as these are very risky pregnancies that can lead to uterine rupture of this ectopic in this location.
- [07:57]
A
Eric, thank you so much for reaching out and for sharing your words of wisdom through Eric's Encounters. Eric's Encounters. That sounds like either a weird store or a weird indie film. Not a sponsor anyway. And thank you again to our producer who is doing his own thing. And I reached out to him, I said, man, I know we're not scheduled to do this. Can you please put something together real quick as an ad hoc brief supplement to our immediate past release? And in a moment's notice, he said, absolutely. I'm there for you, Doc. What do you need? That's why we have such a great group here. We are One Funky Bonds. Honestly, it does take the entire team from our podcast family members to our internal team to make this work. You all are super special. Thank you all for what you do, because I know that on your day off, this was going above and beyond. We are one Funky Bond. All right, that's enough. All right, everyone. Eric, Dr. Colton, thanks again for your words. And now that we've done all that, podcast family, we will see you on our next regularly scheduled release with a separate topic. But now we will resume your regularly scheduled programming, whatever that may be. Now that we've done all that, let's take it home. Podcast family. We're thankful for all of the support that you've given us throughout the years. This has been the Ob GYN no Spin podcast. We'll see you on the next episode. Sam.