Dr. Chapa's OBGYN No Spin Podcast

Innie vs Outies: no, we are not referring to bellybuttons. In this episode, we’re talking about the labia of the Volva! Does it actually matter? Which one is more common? Now, this episode was actually sparked by a brilliant listener who sent us her question to our IG inbox (as a non-clinician): “Can having an innie labia actually cause me to have recurrent bacterial vaginosis?” Such a good question, right? So today, we’re going to break down what the medical literature actually says about anatomy and BV. Plus, well answer the question: What is ACOG’s stance on electiv...

Marfan syndrome is an autosomal dominant, connective tissue disorder. Because it’s autosomal dominant, an affected parent has a 50% chance of passing the genetic mutation to their offspring in every pregnancy. Approximately 25% of cases actually stem from spontaneous, de novo mutations with no prior family history. In the United States, the prevalence of Marfan syndrome is estimated at roughly 1 in 5,000 individuals. It affects males and females equally across all ethnic backgrounds. Although this topic and condition might sound rare at first glance- Marfan syndrome in pregnancy- it is in our communities, and we need to be ready for the po...

If you’ve ever managed postpartum preeclampsia, you know the clinical gray zone: after an initial intrapartum course of magnesium sulfate, when do you actually restart it for a postpartum, readmission exacerbation? Always? There’s no standard national guidance on this. Every unit seems to do something a little different. In this episode, we’re summarizing a new study looking at practice patterns across the country. This study is actually a survey of US MFM fellowship directors across the ACOG Districts. This publication will be officially released/published in the Journal of Maternal-Fetal and Neonatal Medicine in December 2026. We’ll break...

If you’ve been listening for a while, you might remember an episode we ran about two years ago where we dove deep into the use of low-titer O-positive whole blood in emergency resuscitation. At the time, the consensus in trauma care was leaning heavily "pro"—advocating for getting O-positive blood into bleeding patients fast, especially given the persistent and severe shortages of O-negative inventory. Fast forward to today, and the conversation around balancing immediate survival against downstream risks has taken center stage. In just the last two months, two major publications have come out with seemingly conflicting perspectives on t...

In June 2026, the ASRM released its updated guidance on recurrent pregnancy loss. This is the most updated guidance in over a decade and includes a decision tree algorithm that starts with a pivotal test. In this episode we will review this “first pass” triage test and provide clinical implications.

1. ASRM CO: https://www.asrm.org/practice-guidance/practice-committee-documents/recurrent-pregnancy-loss-a-committee-opinion-2026/

2. de Assis V, Giugni CS, Ros ST. Evaluation of Recurrent Pregnancy Loss. Obstet Gynecol. 2024 May 1;143(5):645-659. doi: 10.1097/AOG.0000000000005498. Epub 2024 Jan 4. PMID: 38176012.

Currently, the CDC U.S. Medical Eligibility Criteria (USMEC) rate CHCs as category 4 (unacceptable health risk) for migraine with aura, versus category 2 for migraine without aura; ACOG similarly recommends avoiding estrogen-containing contraception in migraine with aura. But, recent data published in August 2026 from the UK seems to show no increased risk with “modern”/low-dose combination birth control pills when compared to progesterone only options. Is the CDC contraindication out outdated? Not quite. Listen in for details.

1. https://www.podcastrepublic.net/podcast/1412385746Ihara K, et al. Estrogen exposure from modern contraceptives and vascular risk in women with migraine: A na...

A growing body of research reveals the link between STIs and the pathogens that cause most cases of vaginitis. Over 90% of vaginitis cases result from BV, yeast, or trich- alone or in combination. But, a recent 2024 study from Schwebke et al., in the J Clinical Microbiology, found that about 1 in 5 women who presented with symptoms of vaginitis also had at least one STI…a good reminder to not just stop at a VP3 or wet mount. Additionally, women who tested positive for BV had an STI infection rate double the rate found in women who tested negative for BV. In...

An important clinical advantage of cfDNA screening for autosomal recessive conditions is its ability to provide meaningful fetal risk assessment in general-risk pregnancies at an early gestational age, even when partner carrier testing is unavailable. But is this reflex cell-free DNA approach reliable. In this episode, we will review NEW DATA (Oct 2026) from a prospective, multi-site study whose goal was to “evaluate the clinical performance of cell- free DNA (cfDNA) screening as a primary screening tool for autosomal recessive conditions in a large, prospective, general-risk population”. We will review the sensitivity, specificity, PPV and NPV of this (UNITY) approach.

Welcome back to the show, everyone! Today, we are diving deep into one of the most effective, set-it-and-forget-it contraceptive options available: the Nexplanon implant. With a failure rate of about 0.05%, it is a powerhouse of birth control. You pop it just under the skin of the inner upper arm, and for up to five years, you are covered. Standard removal is usually a quick, straightforward, in-office visit. But what happens when you go to feel for the implant... and it’s not palpable? That single scenario can be incredibly anxiety-provoking—both for the patient lying on the table and for...

Picture this common, late-gestation conundrum: You’re reviewing a 34-week sono. The mid-pregnancy 24-to-28-week glucose screen was completely normal. But now, the sonogram pops up with an estimated fetal weight of over 90%, or maybe a MVP (or AFI) that’s overtly elevated. The classic clinical dilemma hits: Do you order a repeat OGTT this late in the game? Is it actually worth poking the patient again, or are you just chasing shadows? Well, we now have new meta-analytic data. Today, we are reviewing fresh, high-yield data hot off the press from the American Journal of Obstetrics & Gynecology (OCT 2026). We’r...

Today we’re diving into a lab order that almost every ob-gyn, midwife, and labor-and-delivery nurse were traditionally trained to do: the routine Postpartum Day 1 Hemoglobin and hematocrit. For decades, checking a patient’s H&H after delivery was automatic. Didn’t matter if it was a smooth, uncomplicated vaginal birth with minimal blood loss or a complex emergency C-section- come 6:00 AM the next morning, someone was drawing blood. Historically, the logic felt airtight: First, visual estimation of blood loss (the EBL) during delivery is notoriously inaccurate; clinicians often underestimate heavy bleeding by as much as 30 to 50 percent. Second, severe...

If you’ve been following health and medical headlines over the past few weeks, you’ve likely seen a renewed and urgent conversation around postpartum depression—a condition that affects millions of new mothers worldwide, often with devastating consequences. While we’ve long understood that postpartum depression is deeply multifactorial—shaped by a complex web of hormonal shifts, psychological stressors, and socio-economic factors—a compelling wave of new data points to a key physical variable that might be playing a far bigger role than we previously realized: how we manage pain during cesarean deliveries. Specifically, emerging studies are highlighting a striking p...

MS is a complex polygenic disease with over 200 associated genetic variants. The risk of an offspring developing MS if one parent is affected is relatively low at 2% to 3% (though maternal transmission shows slightly higher heritability), with some possible epigenetic influences. The National Multiple Sclerosis Society reports that up to 4 times as many women have MS as men. The average age at MS diagnosis is around 30 years. Studies show this ratio has grown over the past several decades; in the mid-20th century, the ratio was roughly 2:1, but the proportion of affected females has steadily increased due to a combination...

The ACOG PB 222 states, “In women with preeclampsia with severe features at less than 34 0/7 weeks of gestation, with stable maternal and fetal condition, expectant management may be considered”. The expectant management of preeclampsia with severe features before 34 0/7 weeks of gestation is based on strict selection criteria of those appropriate candidates and is best accomplished in a setting with resources appropriate for maternal and neonatal care. BOX 4 in that ACOG guidance lists “Conditions Precluding Expectant management”, with one of the conditions being “Uncontrolled severe-range blood pressures (persistent systolic blood pressure 160 mm Hg or more or diastolic blood pressure 110 mm Hg or more no...

So, here is a not uncommon situation: A new OB patient presents for initial prenatal care at 28 weeks by “sure LMP” but her ultrasound EGA is just over 3 weeks behind. Simple redating, right? How can we be assured that we are not missing FGR? That is where the “ancillary” use of transcerebellar diameter (TCD) plays a role. In this episode, we will highlight the recent JUNE 2026 data on this and review the 4 scenarios when this supplemental ultrasound finding can play a vital role.

1. Fetal Transcerebellar Diameter Measurement With Particular Emphasis in the Third Trimester: A Reliable Predictor of Gesta...

Today we are diving into a topic that is incredibly close to my heart—one that has the potential to fundamentally change how we approach prenatal care and protect pregnant patients. We’re talking about low-dose aspirin for the prevention of hypertensive disorders of pregnancy. Now, if you follow current formal guidelines, you probably know the standard protocol: 81 milligrams a day, prescribed based on specific risk factors. But there’s a growing body of evidence suggesting we might be underdosing—and under-prescribing. What if 162 milligrams taken universally across the board is actually far more effective?In today’s episode, we’re unpa...

Today, we are tackling a massive grey area in obstetrics/maternal-fetal medicine: What happens after early fetal growth restriction resolves? When a baby bounces back on the growth chart during the second or third trimester, are they completely out of the woods? Or is there a hidden, lingering risk we aren’t talking about enough? To find out, we’re doing a deep dive into two major publications that dropped just this month, in August 2026 in sister journals (AJOG and AJOG MFM). Both are retrospective, both ask the exact same burning question…and get this: they arrive at completely opposi...

The word CERCLAGE comes from the French word, cercle, meaning "hooping" or "encirclement". Cerclage was traditionally reserved for cervical insufficiency but is now a recognized option for patients with a history of preterm birth and a short cervix noted on ultrasound between 16-24 weeks. There are three (3) main indications for obstetrical, cervical cerclage: History-Based, Ultrasound-Based, and Physical- Exam Based. In this episode, we will summarize the key takeaways from the new ACOG CPG on OBSTETRICAL CERCLAGE, being released in September 2026.

1. ACOG CPG, Obstertrical Cerclage, Sept 2026

2. ACOG Practice Bulletin #234: Prediction and Prevention of Spontaneous Preterm Birth, 2021<...

As of August 20th, 2026, the ACOG has released an updated Clinical Practice Update on opportunistic salpingectomy. Here’s why this matters so much: we now know that the vast majority of high-grade serous epithelial ovarian cancers actually start not in the ovaries, but in the fallopian tubes. By removing those tubes during routine pelvic, obstetric, or even non-gynecologic abdominal surgeries, we aren't just performing standard procedures—we are drastically cutting the lifetime risk of epithelial ovarian cancer by up to 78%. Today, we’re breaking down what’s inside ACOG’s latest guidance, how surgical practices are shifting, and why this simpl...

ACOG recommends the use of oral or vaginal misoprostol, vaginal dinoprostone (either gel or insert), or mechanical methods for cervical ripening. Plus, it states, “Combination methods (pharmacologic and mechanical) are also effective”. The July 2026 ACOG CPG 9 states this regarding vaginal misoprostol compared to vaginal dinoprostone for labor induction: “Vaginal dinoprostone is effective for cervical ripening; however, vaginal misoprostol has higher efficacy and less need for oxytocin augmentation. The Cochrane database systematic review in 2010 that compared vaginal misoprostol with vaginal dinoprostone in 38 trials (7,022 participants) showed a lower rate of failure to achieve vaginal delivery in 24 hours (RR 0.77) and reduced need for ox...

Today, we are taking a deep dive into a medical truth that sounds completely counterintuitive, almost upside down, based on everything you think you know about women's health. But here’s the kicker: it’s actually nothing new at all. For over two decades, ever since the landmark Women’s Health Initiative (WHI) study made global headlines back in 2002, the blanket narrative surrounding menopausal hormone therapy has been clear and persistent: hormones equal breast cancer risk. But there is a massive asterisk in that science that got completely lost in the media noise. While combination therapy with conjugated equine estrog...

Historically, continuous intravenous (IV) insulin infusions were established as the standard of care for pregestational diabetes (Type 1 and Type 2 DM) during labor to prevent acute intrapartum hyperglycemia and minimize the risk of neonatal hypoglycemia. Intravenous insulin offers rapid titration, immediate onset, and a short half-life, allowing precise real-time glycemic control during the physiological stress and fluctuating metabolic demands of labor. Maintaining euglycemia intrapartum is emphasized because elevated maternal blood glucose levels cross the placenta, inducing fetal hyperinsulinemia, which acutely increases the risk of severe post-delivery neonatal hypoglycemia, which can be problematic. Although IV insulin protocols are widely used and...

Urge urinary incontinence (UUI) places a significant emotional and physical burden on women affected. Sacral neuromodulation has been and remains a well-established implant-based therapy for UUI. The concept originated in the early 1970s from sacral anterior root stimulation research for neurogenic bladder, with human clinical trials beginning in 1982. Medtronic's InterStim device received FDA approval in 1997 for UUI, and in 1999 for urgency-frequency and nonobstructive urinary retention. This was a game changer for affected women. Now, as of August 5, 2026, the FDA has granted 510(k) clearance for a new, less invasive neuromodulation implant- placed in the ANKLE. This is the Revi Extend...

Today, we are taking a deep dive into an intervention that almost every labor and delivery unit in North America has adopted over the last decade: Quantitative Blood Loss, or QBL. ACOG first recommended quantitative blood loss assessment in Committee Opinion Number 794, published in December 2019. This opinion recommended that every birthing facility implement a standardized, quantitative method for measuring cumulative blood loss at all deliveries, replacing visual estimation as the default approach. This built on earlier ACOG efforts, including the 2015 reVITALize initiative, which standardized obstetric data definitions and defined postpartum hemorrhage using cumulative measured blood loss thresholds (≥1,000 mL regardless of...

Today, we’re stepping into one of the most clinically delicate and emotionally heavy scenarios you can encounter in women's healthcare: a mid-pregnancy loss, say right around that 18 to 20-week mark. It’s a situation where the clinical room feels still, the emotional weight is immense, and every decision you make as a clinician carries profound gravity. Picture the scenario: The delivery has occurred. Both the fetus and the placenta have delivered, and upon gross visual examination on the delivery tray, the placenta appears intact. The immediate crisis of delivery has passed. But as the attending provider, you’re now st...

Today, I want to tell you a story that sounds like it was completely made up for a movie script, but it’s 100% real. Imagine an automotive mechanic in Argentina. He has zero medical training, no background in obstetrics, and no clinical degree. One night, he sees a simple party trick on YouTube: how to get a lost cork out of the inside of an empty wine bottle using nothing more than an inflated plastic bag. Most people would laugh, finish their glass of wine, and move on. But this mechanic, Jorge Odón, looked at that plastic bag and...

ACOG first recommended antiviral suppressive therapy at 36 weeks of gestation for women with a history of genital herpes in 2007, with the publication of Practice Bulletin No. 82 ("Management of Herpes in Pregnancy," June 2007). This was the first ACOG practice bulletin specifically dedicated to genital herpes management in pregnancy, and it established the 36-week suppressive therapy recommendation based on the RCTs available at that time (including the Watts 2003, Sheffield 2006, and Andrews 2006 trials). The recommendation was subsequently reaffirmed and updated in Practice Bulletin No. 220, published in May 2020, which is the current version. However, these trials had patients who ultimately delivered at/after 38...

Today, we’re diving straight into a topic that hits close to home for millions of patients and providers alike: IUD insertion pain, and more importantly, how we can actually make it better. Now, if you’ve been practicing or following clinical guidelines for a while, you know the frustrating backstory here. For years, the standard advice was simple: "Just take 800 milligrams of ibuprofen an hour before your appointment." But a 2015 double-blinded, randomized placebo-controlled clinical trial showed that taking a single dose of 800 mg within an hour before insertion did not relieve procedural pain. That was published in the jour...

Podcast family, we pride ourselves on this show on being avant-garde and forward thinking on the topics we choose. For example, on February the 20th, 2026, we released an episode called “New Data: Screen Maternal Ferritin with Prenatal Care?” In that episode we reviewed a publication from the previous month (January 2026) that was released in Lancet Hematology. This study made the case for screening for early iron deficiency, even without anemia, with serum ferritin at the initiation of prenatal care. This was a multicenter, 2-arm, randomized controlled trial. Earlier identification of low serum ferritin prevented iron deficiency anemia in the thir...

If you’ve scrolled through your feeds recently, you’ve probably seen the video that’s causing a stir: a prominent infertility doctor sharing her “Hot Take” personal observations on social media, claiming that IUDs are a hidden cause of intrauterine adhesions- or severe uterine scar tissue. Now, Listen. It is completely natural to see a specialist standing in a white coat making a passionate claim and think, "Wow, should I be worried about my birth control?" But here is the reality we need to establish right out of the gate: a handful of individual cases shared online is the very d...

Antenatal corticosteroids are a MAJOR win in the management of preterm labor. An initial course of antenatal corticosteroids has been shown to reduce morbidity and mortality in patients with preterm prelabor rupture of membranes. For patients who remain undelivered after the initial course of antenatal corticosteroids, it is uncertain whether a booster course of antenatal corticosteroids reduces neonatal morbidity or increases the infection risk. The ACOG, in its current guidance, has concluded that the current evidence is insufficient to make a recommendation. Corticosteroids, especially at the doses given, are also powerful immunosuppressants. When you administer that first course, you...

The Bakri Postpartum Balloon was described and first used clinically in 1999 by Dr. Younes N. Bakri (Georgia, USA). It is intended to treat postpartum hemorrhage (PPH). In the United States, it received its first major FDA clearance (via 510(k) for commercial marketing) on April 17, 2002. Manufacturer guidelines for the Bakri (Cook Medical) state that the balloon may be left indwelling for a maximum of 24 hours, but the determination of removal time is left to the clinician once “bleeding is controlled and the patient is stable.” However, the optimal duration of intrauterine balloon tamponade placement remains unclear. One retrospective cohort study from...

Gonadal hormones have a complicated influence on appetite. Estradiol generally suppresses appetite, whereas progesterone opposes estradiol's action such that their combined presence represents a high-risk hormonal milieu for Binge Eating (BE). Testosterone is thought to be associated with increased BE in females but appears protective in males. In some reports, combination oral contraceptive (COC) use has been linked to greater BE-related appetitive processes (e.g., food intake). Now, we have 2 recent, back-to-back publications (June 2026 in JAMA Network Open, and July 2026 in Appetite) that have examined the relationship of hormonal contraception on binge eating behavior. These found seemingly opposing conclusions...

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 Network on July 6, 2026. Premenopausal women aged 22 to 50 years participated from 12 different locations in the US, including my home state of Texas. In this episode, we will highlight this new prospective, interventional, single group nonrandomized cl...

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 win! On the Prenatal side, lack of amniotic fluid (anhydramnios) under 22 weeks has uniformly been regarded as a fatal/lethal condition. This is because of the direct association with previable lack of amniotic flui...

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 and tricks for this very issue.

1. Verspyck E, Douysset X, Roman H, Marret S, Marpeau L. Transecting versus avoiding incision of the anterior placenta previa during cesarean delivery. Int J Gynaecol Obstet. 2015 Jan;12...

In 2018, the ARIVE trial was published in the NEJM revealing that 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 induction of labors at 39 weeks and 0 days, the ACOG released its clinical practice update in Jan 2025 stating, “The optimal timing of delivery for full-term pregnancies (39 0/7 to 40 6/7 weeks of gestation has not been determined”. Now there is new data, released as an article in p...

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 what happens when we step into the OR? Once that scalpel hits the skin for a cesarean section, does the clock matter just as much? There are two separate intervals which have...

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 a gamechanger for a preterm neonate. But there’s a catch. If you give them too early, the benefits fade. If you give them too late and she delivers very quickly, they don't have ti...

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 avoidable readmissions. But the landscape has shifting. In this episode, we are diving deep into why OB providers must optimize blood pressure control before and after postpartum discharge. We’ll be breaking down the landmark 2025 MOPP study, which shook up our traditional targets by examining tight versus standard blood pressure control, alongside the recently rele...