Dr. Chapa’s Clinical Pearls.

Severe nausea and vomiting in pregnancy/hyperemesis gravidarum (HG) takes a toll on patient, and the healthcare system. According to a June 2024 ACOG Clinical Expert Series on the subject, GFD15 and IGFBP7 both play important roles in placentation, appetite, and cachexia that are linked to hyperemesis gravidarum. Specifically, LOW pre-pregnancy GFD15 is associated with increased frequency of HG as GFD15 levels spike post pregnancy in an otherwise "naive" system. Since metformin increases GFD15, can this be a pre-pregnancy, chemoprophylactic option in high risk women? New data just released (June 2025; AJOG) provides some eye-opening insights. Listen in for details.

OASIS (3rd and 4th degree perineal lacerations) occur at a rate of 4-11% (average around 5.5%). OASIS lacerations have both short term and ling term potential morbidities. Practice Bulletin 198, from 2018, briefly discusses counseling patients following OASIS on subsequent mode of delivery options. Now, in a soon to be released AJOG publication, authors have provided a wonderful and comprehensive review on "patient-centered" guidance regarding mode of delivery in a subsequent pregnancy following OASIS. This is a detailed episode, so listen in for the update!

Ladies and gentlemen, welcome back to another addition of “You asked, We answered”! In this brief episode, we will tackle 2 very appropriate clinical questions:1. Why do cervical psychology reports still state the presence or absence of endocervical cells/TZ component if it does not change management, and 2. Does continued magnesium sulfate infusion during C-section increased blood loss? We have done similar “you asked, we answered” episodes in the past and we will continue to do them as questions arise. Listen in for details.

The Bishop Score was originally developed in 1964 by Dr. Edward Bishop and remains the central assessment tool for determining the appropriateness of cervical ripening for labor induction. We have covered pharmacologic and mechanical methods of cervical ripening for labor induction many times in prior episodes. Ut now, in July 2025, there will be a new clinical practice guideline (#9) from the ACOG which has some notable items. Does the ACOG recognize COMBINATION mechanical and pharmacologic agents for cervical ripening for labor induction? What about outpatient cervical ripening? What are the recommended protocols for oral and vaginal prostaglandins? Listen in for details.

Second and/or Third trimester vaginal bleeding is a common reason for L&D Triage patient assessment. The evaluation starts with determining the status of maternal hemodynamic stability. This together with IV access are key first steps. This is followed by an assessment of fetal-placental status. Typically this includes bedside ultrasound for fetal position, visual confirmation of FHTs, amniotic fluid determination, and placental location. At the same time, lab data is obtained to guide care: CBC, fibrinogen, type and RH, and possibly type and cross. Do you order a KB test as part of the STANDRAD evaluation for suspected placental abruption? In this episode, we will review a new study released ahead of print on June 8, 2025 in the European J of Obstetrics, Gynecology, and Repro Biology. Listen in for details.

Antenatal Corticosteroids (ACS) for Fetal Lung Maturation (and more) is an ever evolving saga. This is how science and medicine evolve, by always seeking more information. The effect of antenatal corticosteroids on neonatal/child neurodevelopmental outcomes is controversial and may be influenced by the gestational age at which exposure occurred. In this episode we will highlight TWO recent publications, one from May 2025 (JAMA Netw) and the other from June 2025 (Obstet Gynecol). The first adds data to the "Dose to Delivery interval" question for ACS benefit, and the second article relates to neurodevelopmental outcomes after exposure. Listen in for details.

Innovation in medicine is happening. In our immediate past episode, we summarized how AI is improving standard mammography to now PREDICT breast cancer rather than just diagnosing it once it was appeared. In a past episode, we covered a new and novel “first in class” oral medication for uncomplicated UTIs in women called Blujepa. This is innovation! Well now, as of June 10, 2025, the FDA has granted a New Drud Application for a new and noval oral antibiotic against gonococcal (GC) infection! In this episode, we will review the current CDC treatment protocols for GC and highlight what this new medication’s MOA is and what to expect from this FDA process.

Each year, more than 2.3 million women worldwide are diagnosed with breast cancer—including over 370,000 in the United States alone. For more than 60 years, mammograms have saved lives by detecting early-stage cancers. Now, advancements in AI have lead to a first of its kind breast imaging algorithm that can PREDICT future (5-year) breast cancer risk in the patient (CLARITY BREAST). This is GROUNDBREAKING. Yes, there has been other new tools, like the recent contrast enhanced mammography data, for early detection of breast cancer, but this is the first technology to help PREDICT it in the future. Nonetheless, questions remain. Listen in for details. (CLARITY is not a sponsor)

It’s interesting how, at times, different medical societies can look at the same data and arrive at different recommendations. It happens! In April 2025, the Society of Family Planning (SFP) released its new clinical recommendations for the medical management of early pregnancy loss (EPL), AKA miscarriage. This clinical guidance has 4 remarkably interesting differences when compared to the ACOG practice bulletin # 200 on early pregnancy loss. In this episode, we will review these 4 key differences and summarize the latest recommendations for the medical management of miscarriage. Listen in for details.

The white-coat effect is a measure of blood pressure change from before to during the visit in office/clinic when the blood pressure is recorded by a physician or nurse; this was first described in 1983 by Mancia et al, and was initially thought to represent a benign process. But it was unclear what this actually meant for pregnancy. Ambulatory blood pressure monitoring (ABPM) has been used in pregnancy for about 20 years now. Use of this monitoring option has revealed a subgroup of patients who have persistently high blood pressure (BP) in the presence of health care providers, but a normal ambulatory or self-measured BP. This phenomenon has been termed “White Coat Hypertension” (WCH). In 2013, The International Society for the Study of Hypertension in Pregnancy (ISSHP) published the revised classification for hypertensive disorders in pregnancy, that included WCH, not previously included. The ISSHP guidelines also emphasize that a diagnosis of white coat hypertension in pregnancy should only be considered before 20 weeks of gestation. We now know that WCH, outside of pregnancy, is not an entirely benign process. The role of metabolic risk factors in patients with white-coat hypertension was first outlined in 2000 by Kario and Pickering. When metabolic risk factors are present in association with white-coat hypertension, the increased risk of target organ damage is determined not only by the blood pressure characteristics but also by the metabolic abnormalities. Recognizing the potential risks of white coat hypertension was also published in a commentary in 2016 out of the European Society of Cardiology. That article’s title was, “White-coat hypertension: not so innocent”. But what is the latest data on WCH in pregnancy? Is WCH linked to poor obstetrical outcomes? Does WHC need medication therapy? We have data from 2024 to help us. Listen in for details.