Dr. Chapa’s OBGYN Clinical Pearls

The DIY at-home gynecology health market has EXPLODED. There is at-home vaginal/cervical HPV testing, screening for STIs, and even a blood test for multi-cancer screening (Cancer Guard). These provide a potential solution for access to care and social determinants of health. Now, a new study is seeking to add DIY at-home transvaginal ultrasounds to that mix. Yep…at home. This was published in Jama...

As healthcare professionals, we should all seek and encourage scientific and medical discovery and new therapies. That’s one big goal of the scientific process: to bring new therapies to otherwise lethal condition. For example, back in the 80s and 90s, HIV uniformly led to AIDS, which was a death sentence. But now, HIV is 100% manageable with appropriate medical care and medical therapy. That’s a...

Placenta previa has an incidence of about 0.4% to 0.5% (or 1 in 200 to 1 in 250 deliveries). Anterior placenta previa poses a unique obstacle in fetal extraction at CS: Is it best to transect (enter) the placenta or to cause a marginal abruption at the placental edge for fetal extraction? In this episode we will review an upcoming “Surgeon’s Corner” in the AJOG (July 2026) which provides some tips...

In 2018, the ARIVE trial was published in the NEJM revealingthat induction of labor at 39 weeks reduced cesarean deliveries and gestational hypertension/preeclampsia in low-risk nulliparous women who had labor induced,compared to expectant management. Then, in 2025, and partly in response to L&D units across the country becoming saturated with low- risk, nulliparous patients awaiting their inducti...

If you practice obstetrics, you already know that our entire world is ruled by a stopwatch. Think about it: we are obsessed with time. We wait exactly 60 or 120 minutes for a gestational diabetes challenge. We stare at a monitor for a strict 30 minutes timing a biophysical profile. The entire pregnancy is dictated by an Estimated Date of Delivery that has us counting down the literal days. But wha...

Think about the last time you had to time something perfectly. Maybe it taking that perfect swing at the baseball, or catching a flight after a commute, or making a high-stakes decision. In the world of high-risk pregnancy, clinicians play a constant game of high-stakes timing with a usual medication called antenatal corticosteroids. Given to moms at risk of giving birth early, these steroids are...

More than 60% of maternal deaths occur during the postpartum period, and hypertensive disorders of pregnancy are a major, preventable driver of that statistic. For too long, the transition from labor and delivery to home has been a vulnerable blind spot—leading to high rates of avoidablereadmissions. But the landscape has shifting. In this episode, we are diving deep into why OB providers must opt...

Welcome back to the show, everybody! Today, we are diving deep into the intersection of maternal-fetal medicine and cardiology. We’re tackling a condition that keeps every OB/GYN, MFM, and cardiologist up at night: Peripartum Cardiomyopathy, or PPCM. And to keep our clinical gears turning, we are framing this discussion squarely through the lens of Society for Maternal-Fetal Medicine (SMFM) Consul...

Podcast Family, in this episode we will focus on the “20-minute rule” for vacuum assisted vaginal delivery. This is an important aspect of neonatal safety and is a vital part of procedure documentation. Documentation for vacuum assisted vaginal delivery should include station at application, number of tractions, number of pop-offs and the total traction time and the vacuum trackable time (time fro...

The March 2026 ACC/AHA Guideline on the Management of Dyslipidemia made a major pivot regarding Lipoprotein(a) by establishing a formal recommendation for universal screening in adults. This 2026 guideline, published in the Journal of the American College of Cardiology, issued a Class 1 recommendation stating that every adult should have their Lp(a) measured at least once in their lifetime. Becaus...

Hey everyone, thanks for tuning in. If you’ve spent any time in the OR during a cesarean delivery, you know that the choice between uterine exteriorization and in situ repair usually comes down to how you were trained or personal surgeon preference. It’s a debate as old as modern obstetrics. But a major piece of clarity is coming down the pipeline. This episode, we are getting a sneak peek at a br...

In the ACOG PB 231, Multifetal Gestations Twin Triplet and Higher-Order Multifetal Pregnancies, it states, “based on the improved outcomes reported in singleton gestations, the National Institutes of Health recommends that, unless a contraindication exists, a course of antenatal corticosteroids should be administered to all patients who are at risk of delivery within 7 days and who are between 24...

Historically we were taught as surgeons that 1-centimeter bites that between suture throws on a Pfannenstiel (low transverse) fascial closure was enough to prevent hernia formation and optimize facial healing. But is this still evidence based? We can extrapolate data from a May 2026 systematicreview/meta-anlysis as well as a separate study from the Dutch published in 2021. Both of these studies we...

Today, we are talking about a true paradigm shift in prenatal genetics. For decades, we’ve relied on cell-free DNA for screening, but when it came to definitive confirmation of fetal aneuploidy, we’ve had to counsel our patients through the anxiety and physical risks of invasive procedures like amniocentesis and CVS. But what if the line between screening and confirmation just blurred? In this epi...

Back in June 2024, we highlighted surprising data from JAMA Network Open regarding adolescent care in the ED. Because many adolescents use the ED as their primary care provider, it’s a good opportunity for them to have contraception addressed regardless of why they presented. But that’s not what was happening. That publication from two years ago showed significant gaps in addressing contraception...

It's a QUICKY: IMPROMPTU episode in clinic today..

Welcome back, everyone. Today we're diving into one of the most hotly debated topics in obstetrics- should we be treating preeclampsia without severe features with antihypertensive medications during expectant management? Now, if you've been following the literature- and our show, you know that the landmark CHAP trial changed the game for chronic hypertension in pregnancy. It showed us tha...

The American College of Obstetricians and Gynecologists (ACOG) does not recommend routine ultrasound measurement of the lower uterine segment (LUS) thickness as part of the evaluation for trial of labor after cesarean delivery (TOLAC). ACOG Practice Bulletin No. 205 (2019) on Vaginal Birth After Cesarean Delivery does not include LUS measurement among its recommendations for TOLAC candidacy assess...

Should patients check their own urine protein at home when they have a gestational hypertension DX? After all, home-based BP monitoring is an established part of HDP care. Is there data on home urine protein dipstick tests in gestational hypertension? What do professional guidelines say? And what are the pros and cons of home self-monitoring of urine protein? Thank you, SJ, for the podcast topic s...

The vast majority of the time, “community standard of care” reflects evidence-based recommendations. This means that both the predominance of clinical data and what is clinically practice align one with another period but at times, clinical standard practice doesn't always align with what the data shows. How is this possible? This is exactly the case for home blood pressure monitoring in pregn...

Outside of pregnancy, guidelines emphasize diabetes self-management education and support to facilitate informed decision making, self-care behaviors, problem solving, and active collaboration with health care professionals. This includes, in those with good health literacy, the concept of patient-led self-titration of basal insulin results which has data that it improves glycemic management compa...

Hyperemesis gravidarum (HG) represents the most severe end of the nausea and vomiting of pregnancy spectrum. It has a reported incidence of approximately 0.3–3% of pregnancies and is the most common cause of hospitalization in early pregnancy and the second most common cause of hospitalization in pregnancy overall. In June 2024, the ACOG published a Clinical Expert series summarizing the inpatient...

Cervical exams can be tricky for the novice practitioner. Think about this: it’s a blind exam, we measure that distance using only two fingers, through a layer of tissue, sometimes with a patient moving up on the bed as we examine. That is the reality of a cervical exam. Intrapartum, some nursing staff and clinicians use qualitative descriptors like "a tight 4" or "a generous 5&quot...

Oh, What’s in a Name? Irving F. Stein and Michael L. Leventhal first described the syndrome, originally known as Stein-Leventhal syndrome, in 1935, in the AJOG. They published a case series of seven women displaying a triad of symptoms, including hirsutism, amenorrhea (absent menstruation), and bilaterally enlarged polycystic ovaries. We now know that PCOS affects 1 in 8 women globally (170 millio...

As I have said many times before, some podcast ideas come from REAL clinic encounters. In this episode, Dr Hanna V, our dedicated PGY1 on our call team, and I will answer TWO real questions which arose just today on morning rounds, on our service: 1. Does NORMOTENSIVE HELLP still need Mag Sulfate? And 2. Does an indwelling foley s/p iatrogenic bladder injury at CS require prophylactic antibiotic c...