Dr. Chapa’s OBGYN Clinical Pearls

Words matter, and equally as important, our actions matter. Sometimes the words opportunistic salpingectomy (OPS or OS) are used interchangeably with risk-reducing salpingectomy (RRS). However, these are two completely different items. In fact, there are 4 very important differences between the two. In the April 2026 AJOG, there's a new Clinical Opinion on this very topic. Listen in for detail...

Platelet-rich plasma (PRP) injections do not have formal FDA approval for specific clinical indications. PRP is regulated as an autologous blood product and is used "off-label" in clinical practice. However, there is substantial clinical evidence supporting its use for certain dental surgeries and musculoskeletal conditions, particularly lateral epicondylitis, knee osteoarthritis, and pl...

Podcast family, welcome to Quickie #4. This one will be fun: A. Medicine changes, and changes fast. I trained with and learned the Grannum grading placental system (grades 0-III based on ultrasound appearance). Is that still a thing? We recently found a “grade III placenta at 34 weeks” as an incidental finding. Is there specific management considerations for this? Listen in for details. B. What do...

Well, it's no doubt we live in a culture of immediate gratification. When we need to know something, we must know it immediately! This even applies to couples seeking pregnancy and their desire to find out if their monthly attempts have been successful. However, there is a problem with trying to prove pregnancy too promptly. In this episode, we will review a new publication just released on Ma...

What an AMAZING lesson, Podcast Family, in this impromptu episode, we will hear from one of my former medical students, now BOARD-CERTIFIED OBGYN...and an incredible OB case she just had. Sometimes....we find ZEBRAS! Great job, Lauren!

Podcast family we've all heard the rumors that oursmartphones are “LISTENING TO US”. Well, some of that is actually true, and trust me I'm not a conspiracy theorist. Our smartphones are capable of remarkable things. A new publication from the Green journal (released ahead ofprint on 03/05/2026 ) is proposing that it may now be able to detect fetal movement, fetal breathing, and even fetal...

Neuraxial analgesia (epidural or spinal) combined withtocolytic therapy is the pain control method that best increases the success rate of external cephalic version (ECV), according to the ACOG’s PB 221. However, some patients may be reluctant to use regional anesthesia and may askabout IV analgesia. A new study in the AJOG (released as an ePub on March 5, 2026) provides some insights that may be...

The ACOG 2025 guideline specifically recommends either oral or vaginal misoprostol for cervical ripening; it does not include buccal administration among its endorsed routes. With the rising rates of both obesity and labor induction, understanding the optimal agents for induction in obese patients is crucial. In a new study released ahead of print on March 4, 2026, in the AJOG, investigators from...

In this quickie episode, we will answer a question from one of our podcast family members: “Can a virgin get BV?”. It’s a complicated question, that needs explanation. PLUS, we will relate this to a former “event” from a past president- so listen until the end! 1. Kim ES, Waltmann A, Duncan JA, Hood-Pishchany I.Advances in Treating Bacterial Vaginosis: Recognizing Sexual Transmission and Pipeline...

For preterm prelabor rupture of membranes, the standard protocol for latency augmentation has remained IV amoxicillin and erythromycin for 2 days, followed by oral amoxicillin and erythromycin for 5 additional days. Nonetheless, azithromycinhas largely replaced erythromycin in PPROM management due to supply shortages and tolerability.  Previous retrospective studies (2019) have found no difference...

Well podcast family welcome to the first installment of what will be a periodic recurrence, of our episode called, “QUICKIE”. These are meant to be quick snippet episodes to give a quick fact or medical /clinical reminder in contrast to our regular episodes which are a little bit more in detail and lengthy. In this first installment of our first QUICKIE episode, we're going to tackle the disti...

Probiotics. They are often marketed as the end of all and be all for all our health issues. And they CAN do some real good. There is NO DOUBT a connection with overall heath and gut health…and NO ONE can deny that. But probiotics gets grey for some women’s health issues. A new prospective, single-arm, non-blinded, multicenter study across 31 hospitals in Japan is making some pretty dramatic claims...

Neither the ACOG nor SMFM recommend strict bed rest for preterm birth prevention, or nor preeclampsia. Yet tradition often conflicts with evidence. A prior 2009 survey of MFM specialists, published in the AJOG, on the use of bed rest revealed that 71% used activity restriction in their practice for arrested preterm labor, despite the majority believing it had minimal or no benefit. The authors con...

A study published in Nature Communications, published Feb 19, 2026, found that “pregnancy physically alters a woman’s brain, with a second pregnancy bringing even more profound effects.” The researchers “performed brain scans on 110 women. Some were first-time mothers, others second-time moms, and some nulliparous women. Results showed that during a first pregnancy, the greatest changes occur in t...

Approximately 5–10% of all breast cancers are hereditary, and among those, BRCA1 and BRCA2 mutations are responsible for about 60% of cases. Yet, overall, only about 1-2% of all breast cancers in the general population are caused by BRCA mutations. Once childbearing is complete, the NCCN recommends risk-reducing BSO in patients carrying these mutations. But what about the uterus? Since childbearin...

The ACOG states that, “Iron deficiency anemia during pregnancy has been associated with an increased risk of low birth weight, preterm delivery, and perinatal mortality and should be treated with iron supplementation in addition to prenatal vitamins. In addition, there may be an association between maternal iron deficiency anemia and postpartum depression, with poor results in mental and psychomot...

We recently covered an SMFM abstract that was presented at the annual Pregnancy Meeting held in early February 2026. The authors were from my Alma Mater, UT Southwestern/Parkland Hospital. This was a well-done study comparing 162 milligrams aspirin to 81 milligrams of aspirin. The results were very encouraging! However, aspirin definitely has an awkward acumen. It would be wonderful if ALL the dat...

Well, even though low dose aspirin has been recommended for the reduction of preeclampsia risk for many years, 2 controversies persist: 1. who should get it, and 2. the dose we should use. While the current US recommendation still focuses on 81 mg low dose aspirin, initiated after 12 weeks of gestation (based on risk factors), there's increased movement and growing data supporting both univers...

As BMIs and weights increase across the US population, there have been increased calls for universal screening for existing DM at entrance to prenatal care, if under 20 weeks. Others, including the ACOG, prefer to screen early those with additional risk factors (like prior GDM HX, prior macrosomia, BMI >30, PCOS, first degree relative with diabetes, or age >40). In July 2024, the ACOG releas...

There has been a shift in cervical cancer screening from primary cytology based to HPV based. Even HPV screening has had its evolution from physician collected samples to patient self-collection, either in a clinical setting or at home with an approved collection system. In May 2025, the FDA cleared the first at-home self-collection kit for HPV screening, specifically the Teal Wand by Teal Health....

Well podcast family, we are back with another installment of our “You ask, We answer” edition. We've got 2 fascinating and real-world clinical conundrums in this episode, both suggested by two separate podcast family members. The first has to do with RH IG maternal administration. Here's the question: If a patient receives routine, prophylactic RH IG at 28 weeks but then has maternal traum...

Fetal Microcephaly has an incidence of 2 to 12 in10,000 births in the USA and can be diagnosed prenatally via ultrasound (in second or early third trimester) or postnatally via measurement of head circumference (HC).  Antepartum, this is a unique diagnosis since we are mainly used to using PERCENTAGES for biometrics and for fetal weight, butmicrocephaly is not diagnosed by HC percentage- but by St...

Stress fractures are common injuries in athletes and military recruits, that’s’ understandable- based on the physical forces placed on the long bones. A stress fracture can be defined as a partial or complete fracture of the bone that is a result from repeated application of stress lower than that required to fracture the bone in a single loading situation. In pregnancy, the body is subjected to v...

We have learned a lot about extended spectrum coverage of prophylactic antibiotics for cesarean section. The landmark C/SOAP trial randomized 2,013 women undergoing nonelective cesarean delivery to azithromycin 500 mg IV plus standard prophylaxis versus placebo, demonstrating a 51% reduction in the composite outcome of endometritis, wound infection, or other infection. Adjuvant Zmax (plus standard...

We have covered the subject of whether to include the decidual (innermost) layer when closing the uterine incision during cesarean section (CS) on at least 2 episodes. The most recent was in September 2025, when we focused on a published (September 2025) systematic review and meta-analysis from the Green Journal. Back then, we compared those new findings to our prior episode from 2023 on the same...