Dr. Chapa’s OBGYN Clinical Pearls

00:23:48

ASRM RPL “UPDATE” 2026

Dr. Chapa’s OBGYN Clinical Pearls ·

2026/10/05

In June 2026, the ASRM released its updated guidance on recurrent pregnancy loss. This is the most updated guidance in over a decade and includes a decision tree algorithm that starts with a pivotal test. In this episode we will review this “first pass” triage test and provide clinical implications.1. ASRM CO: https://www.asrm.org/practice-guidance/practice-committee-documents/recurrent-pregnancy-loss-a-committee-opinion-2026/2. de Assis V, Giugni CS, Ros ST. Evaluation of Recurrent Pregnancy Loss

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00:24:34

New Data on CHC with MwA

Dr. Chapa’s OBGYN Clinical Pearls ·

2026/10/02

Currently, the CDC U.S. Medical Eligibility Criteria (USMEC) rate CHCs as category 4 (unacceptable health risk) for migraine with aura, versus category 2 for migraine without aura; ACOG similarly recommends avoiding estrogen-containing contraception in migraine with aura. But, recent data published in August 2026 from the UK seems to show no increased risk with “modern”/low-dose combination birth control pills when compared to progesterone only options. Is the CDC contraindication out outdated? Not

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00:11:12

Neg Trich on VP3 but Positive NAAT? Why?

Dr. Chapa’s OBGYN Clinical Pearls ·

2026/09/29

A growing body of research reveals the link between STIs andthe pathogens that cause most cases of vaginitis. Over 90% of vaginitis cases result from BV, yeast, or trich- alone or in combination. But, a recent 2024 study from Schwebke et al., in the J Clinical Microbiology, found that about 1 in 5 women who presented with symptoms of vaginitis also had at least one STI…a good reminder to not just stop at a VP3 or wet mount. Additionally, women who tested positive for BV had an STI infection rate

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00:26:04

cfDNA Reflex Testing for Autosomal Recessive Fetal...

Dr. Chapa’s OBGYN Clinical Pearls ·

2026/09/26

An important clinical advantage of cfDNA screening for autosomal recessive conditions is its ability to provide meaningful fetal risk assessment in general-risk pregnancies at an early gestational age, even when partner carrier testing is unavailable. But is this reflex cell-free DNA approach reliable. In this episode, we will review NEW DATA (Oct 2026) from a prospective, multi-site study whose goal was to “evaluate the clinical performance of cell- free DNA (cfDNA) screening as a primary screening

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00:27:29

ENTG New Removal Guidance (SGP Article in Press)

Dr. Chapa’s OBGYN Clinical Pearls ·

2026/09/23

Welcome back to the show, everyone! Today,we are diving deep into one of the most effective, set-it-and-forget-it contraceptive options available: the Nexplanon implant. With a failure rate of about 0.05%, it is apowerhouse of birth control. You pop it just under the skin of the inner upper arm, and for up to five years, you are covered. Standard removal is usually a quick, straightforward, in-office visit. But what happens when you go to feel for the implant... and it’s not palpable? That single

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00:28:11

Retest GDM Late 3rd Tri for LGA or Poly? (OCT 2026 Data)

Dr. Chapa’s OBGYN Clinical Pearls ·

2026/09/20

Picture this common, late-gestation conundrum: You’re reviewing a 34-week sono. The mid-pregnancy 24-to-28-week glucose screen was completely normal. But now, the sonogram pops up with an estimated fetal weight of over 90%, or maybe a MVP (or AFI) that’s overtly elevated. The classic clinical dilemma hits: Do you order a repeat OGTT this late in the game? Is it actually worth poking the patient again, or are you just chasing shadows? Well, we now have new meta-analytic data. Today, we are reviewing

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00:13:06

Routine pp Hgb?

Dr. Chapa’s OBGYN Clinical Pearls ·

2026/09/17

Today we’re diving into a lab order that almost every ob-gyn, midwife, and labor-and-delivery nurse were traditionally trained to do: the routine Postpartum Day 1 Hemoglobin and hematocrit. For decades, checking a patient’s H&H after delivery was automatic. Didn’t matter if it was a smooth, uncomplicated vaginal birth with minimal blood loss or a complex emergency C-section- come 6:00 AM the next morning, someone was drawing blood. Historically, the logic felt airtight: First, visual estimation

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00:25:01

General Anesthesia and PP Mood Disorders

Dr. Chapa’s OBGYN Clinical Pearls ·

2026/09/15

If you’ve been following health and medical headlines over the past few weeks, you’ve likely seen a renewed and urgent conversation around postpartum depression—a condition that affects millions of new mothers worldwide, often with devastating consequences. While we’ve long understood that postpartum depression is deeply multifactorial—shaped by a complex web of hormonal shifts, psychological stressors, and socio-economic factors—a compelling wave of new data points to a key physical variable that

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00:27:08

MS and Pregnancy (Sept 2026 Expert Review)

Dr. Chapa’s OBGYN Clinical Pearls ·

2026/09/12

MS is a complex polygenic disease with over 200 associated genetic variants. The risk of an offspring developing MS if one parent is affected is relatively low at 2% to 3% (though maternal transmission shows slightly higher heritability), with some possible epigenetic influences. The National Multiple Sclerosis Society reports that up to 4 times as many women have MS as men. The average age at MS diagnosis is around 30 years. Studies show this ratio has grown over the past several decades; in the

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00:18:04

What Defines “Refractory” HTN for Preterm sPreE...

Dr. Chapa’s OBGYN Clinical Pearls ·

2026/09/09

The ACOG PB 222 states, “In women with preeclampsia with severe features at less than 34 0/7 weeks of gestation, with stable maternal and fetal condition, expectant management may be considered”. The expectant management of preeclampsia with severe features before 34 0/7 weeks of gestation is based on strict selection criteria of those appropriate candidates and is best accomplished in a setting with resources appropriate for maternal and neonatal care. BOX 4 in that ACOG guidance lists “Conditions

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00:18:35

The Cerebellum (TCD) as EGA Referee

Dr. Chapa’s OBGYN Clinical Pearls ·

2026/09/06

So, here is a not uncommon situation: A new OB patient presents for initial prenatal care at 28 weeks by “sure LMP” but her ultrasound EGA is just over 3 weeks behind. Simple redating, right? How can we be assured that we are not missing FGR? That is where the “ancillary” use of transcerebellar diameter (TCD) plays a role. In this episode, we will highlight the recent JUNE 2026 data on this and review the 4 scenarios when this supplemental ultrasound finding can play a vital role. 1. Fetal

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00:21:40

Parkland Universal LDA (162mg) Preg Study

Dr. Chapa’s OBGYN Clinical Pearls ·

2026/09/03

Today we are diving into a topic that is incredibly close to my heart—one that has the potential to fundamentally change how we approach prenatal care and protect pregnant patients. We’re talking about low-dose aspirin for the prevention of hypertensive disorders of pregnancy. Now, if you follow current formal guidelines, you probably know the standard protocol: 81 milligrams a day, prescribed based on specific risk factors. But there’s a growing body of evidence suggesting we might be

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00:24:47

“Resolved” Early FGR: Now What?

Dr. Chapa’s OBGYN Clinical Pearls ·

2026/08/31

Today, we are tackling a massive grey area in obstetrics/maternal-fetal medicine: What happens after early fetal growth restriction resolves? When a baby bounces back on the growth chart during the second or third trimester, are they completely out of the woods? Or is there a hidden, lingering risk we aren’t talking about enough? To find out, we’re doing a deep dive into two major publications that dropped just this month, in August 2026 in sister journals (AJOG and AJOG MFM). Both are

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00:26:23

New CPG on OB CERCLAGE (Sept 2026)

Dr. Chapa’s OBGYN Clinical Pearls ·

2026/08/28

The word CERCLAGE comes from the French word, cercle, meaning "hooping" or "encirclement". Cerclage was traditionally reserved for cervical insufficiency but is now a recognized option for patients with a history of preterm birth and a short cervix noted on ultrasound between 16-24 weeks. There are three (3) main indications for obstetrical, cervical cerclage: History-Based, Ultrasound-Based, and Physical- Exam Based. In this episode, we will summarize the key takeaways from the

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00:20:29

New CPU on OPS!

Dr. Chapa’s OBGYN Clinical Pearls ·

2026/08/25

As of August 20th, 2026, the ACOG has released an updated Clinical Practice Update on opportunistic salpingectomy. Here’s why this matters so much: we now know that the vast majority of high-grade serous epithelial ovarian cancers actually start not in the ovaries, but in the fallopian tubes. By removing those tubes during routine pelvic, obstetric, or even non-gynecologic abdominal surgeries, we aren't just performing standard procedures—we are drastically cutting the lifetime risk of

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00:15:52

Vag Miso vs Vag Dino: New Meta-analysis (Aug 2026)

Dr. Chapa’s OBGYN Clinical Pearls ·

2026/08/22

ACOG recommends the use of oral or vaginal misoprostol, vaginal dinoprostone (either gel or insert), or mechanical methods for cervical ripening. Plus, it states, “Combination methods (pharmacologic and mechanical) are also effective”. The July 2026 ACOG CPG 9 states this regarding vaginal misoprostol compared to vaginal dinoprostone for labor induction: “Vaginal dinoprostone is effective for cervical ripening; however, vaginal misoprostol has higher efficacy and less need for oxytocin augmentation

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00:17:28

Estrogen’s Protection Against Breast CA: The...

Dr. Chapa’s OBGYN Clinical Pearls ·

2026/08/19

Today, we are taking a deep dive into a medical truth thatsounds completely counterintuitive, almost upside down, based on everything you think you know about women's health. But here’s the kicker: it’s actually nothing new at all. For over two decades, ever since the landmark Women’sHealth Initiative (WHI) study made global headlines back in 2002, the blanket narrative surrounding menopausal hormone therapy has been clear and persistent: hormones equal breast cancer risk. But there is a massive

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00:26:06

SC v IV Insulin Intrapartum

Dr. Chapa’s OBGYN Clinical Pearls ·

2026/08/16

Historically, continuous intravenous (IV) insulin infusions were established as the standard of care for pregestational diabetes (Type 1 and Type 2 DM) during labor to prevent acute intrapartum hyperglycemia and minimize the risk of neonatal hypoglycemia. Intravenous insulin offers rapid titration, immediate onset, and a short half-life, allowing precise real-time glycemic control during the physiological stress and fluctuating metabolic demands of labor. Maintaining euglycemia intrapartum is

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00:12:27

Intro to REVI EXTEND IMPLANT (Not a sponsor)

Dr. Chapa’s OBGYN Clinical Pearls ·

2026/08/12

Urge urinary incontinence (UUI) places a significant emotional and physical burden on women affected. Sacral neuromodulation has been and remains a well-established implant-based therapy for UUI. The concept originated in the early 1970s from sacral anterior root stimulation research for neurogenic bladder, with human clinical trials beginning in 1982. Medtronic's InterStim device received FDA approval in 1997 for UUI, and in 1999 for urgency-frequency and nonobstructive urinary retention. This

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00:18:43

The QBL Paradox: Precision vs. Performance in OB...

Dr. Chapa’s OBGYN Clinical Pearls ·

2026/08/09

Today, we are taking a deep dive into an intervention that almost every labor and delivery unit in North America has adopted over the last decade: Quantitative Blood Loss, or QBL. ACOG first recommended quantitative blood loss assessment in Committee Opinion Number 794, published in December 2019. This opinion recommended that every birthing facility implement a standardized, quantitative method for measuring cumulative blood loss at all deliveries, replacing visual estimation as the default

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