Dr. Chapa's OBGYN No Spin Podcast

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 device that 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 wo...

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 before the 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 (PFM): Can a patient have IAI without fever? That question is really deep and highlights a gap in the curre...

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 fan...

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. (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 patient adhe...

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 devastating outcomes asso...

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

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 obstetrician J...

Misoprostol, as an E1 prostaglandin, is primarily used in obstetrics for cervical ripening (when the Bishop Score is under 6) and/or for labor INDUCTION (to begin labor). IV oxytocin is the principal agent used to augment labor, as needed, once labor has begun. In the US, misoprostol is not typically used after 4-6 cm cervical dilation. However, in a patient who requires augmentation, and who decl...

Actinomyces species are considered part of the normal vaginal and urogenital tract flora. The percentage of Pap smears containing Actinomyces-like organisms varies but is most commonly reported as approximately 7% among women using IUDs. That number is supported by multiple sources, including the Infectious Diseases Society of America guideline and several clinical studies. The incidence can be hi...

Recurrent pregnancy loss (RPL) affects approximately 5% of couples and is an emotional burden on those affected. There is some evidence that vaginal progesterone supplementation may be considered in patients with recurrent pregnancy loss who are experiencing vaginal bleeding during the first trimester. But what about prophylactic low dose aspirin in the first trimester, or preconceptionally, for u...

Having data is sometimes different than having clinically applicable data. This is exactly the issue with the proposed plan to reduce surgical site infection (SSI) by changing surgical gloves after placental delivery at C-Section. Just 24 hours ago, we received the question from a PGY4 OBGYN resident asking whether the practice of changing surgical gloves at C-Section after placental delivery to r...

Muscular dystrophy (MD) is a group of genetic diseases that affect about 16 to 25 per 100,000 people in the US, with the most common childhood form being Duchenne muscular dystrophy (DMD) and the most common adult form being myotonic dystrophy. The prevalence of DMD is estimated at around 1 in 3,500 live male births. Prenatal carrier screening for this is part of the ACMG Tier 3 expanded carrier p...

Regional anesthesia, typically with a spinal or epidural, has long been favored for cesarean births due in part to concerns about the effects that general anesthesia (GA) may have on newborns at delivery. However, data has shown that up to 1 in 6 women may experience pain with a “topped-off” labor epidural, during the cesarean. A new publication in the journal Anesthesia is now being interpreted a...