Dr. Chapa’s OBGYN Clinical Pearls

As OB healthcare providers, we have several pieces of guidance regarding determination of amniotic fluid volume antepartum. The SMFM has Consult Series #46 (2018), which describes the management of polyhydramnios. We'll touch on that in this episode. However, while we have clear understanding of the increased risks of oligohydramnios, where an MVP is preferred for diagnosis over AFI, we have l...

Back in March of 2025, the green journal (obstetrics andgynecology) published A systematic review and meta-analysis on 2 medications (non-hormonal) and their efficacy in menopausal hot flash relief period these medications were Fezolinetant and Elinzanetant. However, the editors have just recently released an “Expression of Concern” about this review. Listen in for details. 1.     Menegaz de Almei...

Implanon (etonogestrel implant) first received FDA approval in 2006, followed by the improved, radiopaque version, Nexplanon, approved by the FDA in 2010, which is now the only contraceptive implant available in the U.S. It was originally FDA approved for a 3-year use duration, although peer reviewed clinical data had demonstrated efficacy through year 5. Now, as of January 2026, the FDA has forma...

Ursodiol (ursodeoxycholic acid) is a prescription bile acid medication used to dissolve cholesterol gallstones, prevent gallstones during rapid weight loss, and treat liver diseases like primary biliary cholangitis (PBC) by reducing toxic bile acids and cholesterol production. It works by changing bile composition, making it less saturated with cholesterol, and is available as oral medication. Of...

HCG is a heterodimeric glycoprotein typically produced by trophoblastic tissue. However, there are occasions where a serum HCG is obtained that remains low level POSITIVE, yet the patient is not pregnant, nor does she have a gynecologic malignancy. Why dose this happen. Not all these instances can be explained by the “PHANTOM” HCG. In this episode, we will review a new Clinical Consensus guideline...

The ENG implant has data placing it as the most reversible, hormonal contraceptive agent available with a typical use failure rate of 0.05%. Unfavorable bleeding patterns, such as frequent or prolonged bleeding, affect approximately 40% of ENG implant users within the first 3 months but typically improve over time. Nonetheless, it is the main reason for patient discontinuation. In the past, variou...

It’s a controversial topic: the impact of uterine incision (hysterectomy) on the neonate delivery interval (also called the U-D interval). Does it matter? Just to be clear, we’re talking about time from uterine entry to fetal extraction, not skin incision to fetal extraction. Past publications have produced conflicting results, often limited by small sample sizes, heterogeneous indications for del...

In January 2026, the ACOG released its Practice Advisory on Screening for fetal Chromosomal Abnormalities. This comes after its Nov 2025 endorsement of the SMFM’s Consult Series #74, “Cell-free DNA screening for aneuploidies: Updated guidance”. In this episode we will review the key parts of this PA. Is screening for microdeletions recommended? PLUS, we will focus on cfDNA for sex chromosomal abno...

Uterine rupture or dehiscence associated with TOLAC results in the most significant increase in the likelihood of additional maternal and neonatal morbidity. It should be noted that the terms “uterine rupture” and “uterine dehiscence” are not consistently distinguished from each other in the literature and often are used interchangeably. Furthermore, the reported incidence of uterine rupture varie...

Currently, as of today’s date, neither the ACOG nor SMFM currently support routine early induction of labor for suspected fetal macrosomia, instead recommending individualized counseling and reserving elective cesarean for extreme estimated fetal weights. However, a 2025 multicenter, open-label, randomized controlled trial was published in the Lancet comparing induction of labor versus standard ca...

In mid-December 2025, the FDA approved an at home devicethat aims to treat depression by sending electric current into a part of the brain (the prefrontal cortex) known to regulate mood. This has been available in the UK since 2019 but it is new to the US. The manufacturer has stated that over 55,000 patients have used the device across Europe, the UK, Switzerland, and Hong Kong. How does this wor...

While endometriosis is highly associated with Chronic Pelvic Pian (CPP), some women may suffer from a different primary or coexistent secondary etiology: pelvic vascular congestion, called vascular origin (VO)- CPP. Although controversial as an entity, there have been diagnostic algorithms published (via pelvic ultrasound. MRI, or venography) for this condition. Approximately 10-40% of chronic pel...

A brief THANK YOU prior to 2025 end.

In 2002, the National Institute of Child Health and Human Development (NICHD) proposed the 3-Tier fetal heart rate (FHR) classification system that was subsequently adopted by many organizations, categorizing tracings into three groups: Category I (normal), Category II (indeterminate), and Category III (abnormal). Recently, our podcast team received an interesting question form one of our podcast...

Podcast Family, in our immediate past episode we tackled the discrepancy that is often found between a clinical diagnosis of intra-amniotic infection/chorioamnionitis and histological chorioamnionitis. From that episode, we received a fantastic question from one of our podcast family members: Can a patient have IAI without fever? That question is really deep and highlights a gap in the current dia...

Welcome to "Labor & Delivery Debrief," the podcast where we tackle your toughest questions about childbirth and maternal health. Today, we're diving deep into a fascinating and critical topic sent in by one of our listeners, Sarah. Sarah asks: "Is it possible for a clinical diagnosis of chorioamnionitis to not be confirmed by placental histology? And if so, how is that possible?" This is a fantast...

Depo-Provera was approved in 1992 by U.S. regulators. About 1 in 4 sexually active women in the United States have used the shot at some point, according to the U.S. Centers for Disease Control and Prevention (CDC). Meningiomas are common intracranial tumors with a female predominance. In fact, they are the most common primary brain tumor in women, with an incidence of approximately 12.76 per 100,...

The second stage of labor, characterized by active pushing and the descent of the fetal head, can be a challenging and prolonged phase for both mother and baby. Various interventions have been explored to optimize this stage, and one such technique involves the application of vaginal lubricants. The rationale behind this approach is to reduce friction between the fetal head and the birth canal, po...

Within the last few days, there has been breaking news regarding the war on gonorrhea. Nuzolvence (zoliflodacin) was FDA approved on December 13, 2025, and Blujepa (gepotidacin) was FDA approved on December 11, 2025.These new oral treatments are particularly important given the global rise in gonococcal drug resistance and the convenience they offer over injectable options, potentially improving p...

It’s so interesting to see how medical evidence evolves, and changes, over time. The result of course is that clinical practice evolves and changes as well. The story of umbilical cord management at time of delivery highlights this very issue very well. The ACOG first recommended delayed cord clamping (DCC) in 2012, for preterm infants, as data showed marked improvement in neonatal outcomes in tha...

Podcast Family, we have covered PCOS on this show many times in the past; and yet- again, there is new information! A new publication from AJOG (Gray journal) describes a new meta-analysis on preconception/continued metformin use in the first trimester. Is this helpful? How does this contrast with the 2023 international guidance update on PCOS? Listen in for details. 1. ASRM: Recommendations from...

Major health organizations, including the CDC and ACOG, recommend universal Hepatitis C Virus (HCV) screening for all pregnant women during each pregnancy and at time of delivery. Ideally, pregnant women should be screened for hepatitis C virus infection at the first prenatal visit of each pregnancy. If the antibody screen result is positive, hepatitis C virus RNA polymerase chain reaction testing...

Welcome to the no spin podcast. In today's episode, we're tackling a subject that's gaining traction but carries significant risks: the freebirth and wildbirth movement. We'll explore the rising trends of unassisted childbirth, where individuals choose to forgo professional medical care during labor and delivery- or during the prenatal period altogether, and the potential devastati...

In 2024, the ASCCP updated their guidance to include DualStain technology as part of primary HPV cervical cancer screening. Now, on December 4, 2025, the ACS has updated their guidance regarding patient self-collectionof vaginal specimens for primary HPV screening. This is fascinating and proves medicine moves fast! Should a negative self-collection test result have a repeatscreen in 1, 3 or 5 yea...

In the original Løvset maneuver (described for breech presentations), the fetus is rotated in one direction to facilitate arm delivery. For shoulder dystocia, the reverse Løvset applies rotation in the opposite direction—specifically rotating the posterior shoulder toward a "belly down" position through up to 180 degrees of rotation. These maneuvers were first described by Norwegian obst...