Dr. Chapa's OBGYN No Spin Podcast

The diagnosis of fetal growth restriction can be made with an isolated abdominal circumference less than the 10th percentile. So is the opposite true? Does a fetal abdominal circumference (isolated) of greater than 90% qualify for “LGA” fetus? In this episode we're going to explain why, although it is logically correct, it is diagnostically incorrect. An isolated abdominal circumference on ultrasound of greater than 90% is however a strong predictive risk factor for one delivery finding. Listen in for details.1. Macrosomia: ACOG Practice Bulletin, Number 216. Obstetrics and Gynecology. 20202. Canavan TP, Hill LM.. Sonographic Biometry in the Early Third Trimester: A Comparison of Parameters to Predict Macrosomia at Birth. Journal of Clinical Ultrasound : JCU. 2015.3. Culliney KA, Parry GK, Brown J, Crowther CA. Regimens of Fetal Surveillance of Suspected Large-for-Gestational-Age Fetuses for Improving Health Outcomes.The Cochrane Database of Systematic Reviews. 2016.

Livi by LiviWell is an FDA-cleared, single-use, soft polyurethane foam device designed to immediately absorb post-intercourse fluids (semen) to support vaginal health. Inserted like a tampon within 15 minutes post-coitus, it works in roughly 60 seconds to restore natural pH, helping to manage odor, dripping, and discomfort. Is this evidence-based? Listen in for details.1. https://www.biospace.com/press-releases/liviwell-secures-fda-clearance-for-livi-introducing-a-new-category-in-post-intercourse-vaginal-care#:~:text=Advertise-,LiviWell%20Secures%20FDA%20Clearance%20for%20Livi%2C%20Introducing%20a%20New%20Category,and%20other%20post%2Dintercourse%20fluids.2. Mngomezulu K, Mzobe GF, Mtshali A, et al. Recent Semen Exposure Impacts the Cytokine Response and Bacterial Vaginosis in Women. Frontiers in Immunology. 2021. 3. Abstract: ISSWSH/ISSM Joint Meeting 2025. Abstract citation ID: qdaf068.138 (155) SEMEN IS NOTTHEVAGINA’SFRIEND:ANOVEL POST-SEX TAMPON IMPROVES VAGINAL HEALTH PARAMETERS

Modern medicine has come a long way in its fight against diabetes. We now have continuous glucose monitors (CGM) and automated insulin delivery (AIDs) systems. These have revolutionized patient care. The FDA has approved devices for use in pregnancy as “nonadjunctive use” (meaning they may be used alone), although capillary finger stick assessments are currently still considered the Gold Standard. While the most robust data in support of CGMs is for preexisting Type 1 DM (Class B or beyond) and Type 2, there is recent growing support for CGM use in GDM patients, although some limitations still apply. Listen in for details.1. Feig DS, et al; CONCEPTT Collaborative Group. Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicentre international randomised controlled trial. Lancet. 2017 Nov 25;390(10110):2347-2359. doi: 10.1016/S0140-6736(17)32400-5. Epub 2017 Sep 15. Erratum in: Lancet. 2017 Nov 25;390(10110):2346. 2. Benhalima K, Durnwald C, Sweeting A et al.Application of continuous glucose monitoring and automated insulin delivery technologies for pregnant women with type 1, type 2, or gestational diabetes: an international consensus statementThe Lancet Diabetes & Endocrinology, 2025; 14, 157-1773. Salmen BM, Reurean-Pintilei D, Salmen T, Bohîlțea RE. Exploring Continuous Glucose Monitoring in Gestational Diabetes: A Systematic Review. Life (Basel). 2025 Aug 28;15(9):1369. doi: 10.3390/life15091369. PMID: 41010309; PMCID: PMC12470761.4. Wyckoff JA, Lapolla A, Asias-Dinh BD, et al.Preexisting Diabetes and Pregnancy: An Endocrine Society and European Society of Endocrinology Joint Clinical Practice Guideline. The Journal of Clinical Endocrinology and Metabolism. 20255. American Diabetes Association Professional Practice Committee for Diabetes*; 15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes—2026. Diabetes Care 1 January 2026; 49 (Supplement_1): S321–S338. https://doi.org/10.2337/dc26-S0156. Burk J, Ross GP, Hernandez TL, Colagiuri S, Sweeting A. Evidence for improved glucose metrics and perinatal outcomes with continuous glucose monitoring compared to self-monitoring in diabetes during pregnancy. Am J Obstet Gynecol. 2025 Sep;233(3):162-175. doi: 10.1016/j.ajog.2025.04.010. Epub 2025 Apr 10. PMID: 40216177.7. Linder T, et al; GRACE study collaborative group. Glycaemic control and pregnancy outcomes with real-time continuous glucose monitoring in gestational diabetes (GRACE): an open-label, multicentre, multinational, randomised controlled trial. Lancet Diabetes Endocrinol. 2026 Jan;14(1):50-61. doi: 10.1016/S2213-8587(25)00288-8. Epub 2025 Nov 24. PMID: 41308662.8. Valent AM, et al. Real-Time Continuous Glucose Monitoring in Pregnancies With Gestational Diabetes Mellitus: A Randomized Controlled Trial. Diabetes Care. 2025 Sep 1;48(9):1581-1588. doi: 10.2337/dc25-0115. PMID: 40730104; PMCID: PMC12368369.9. Kusinski LC, et al. Continuous Glucose Monitoring Metrics and Pregnancy Outcomes in Women With Gestational Diabetes Mellitus: A Secondary Analysis of the DiGest Trial. Diabetes Care. 2025 Aug 19:dc250452. doi: 10.2337/dc25-0452. Epub ahead of print. PMID: 40828742; PMCID: PMC7618813.10. García-Moreno RM, et al. Efficacy of continuous glucose monitoring on maternal and neonatal outcomes in gestational diabetes mellitus: a systematic review and meta-analysis of randomized clinical trials. Diabet Med. 2022 Jan;39(1):e14703. doi: 10.1111/dme.14703. Epub 2021 Oct 13. PMID: 34564868.11. Amylidi-Mohr Set,.et al (DipGluMo): Lancet Diabetes Endocrinol. 2026 Mar;14(3):e6. doi: 10.1016/S2213-8587(25)00403-6. PMID: 40441173.

Podcast family, we have to be careful what we ask for… Because we might just get it! We have been asking for new ways to predict preeclampsia for close to two decades. Well now we have new biomarker serum tests that are even offered direct- to-consumer. The problem is, what do we do with a positive test?! In a past episode we covered an FDA cleared serum test by Thermo Fisher for use in patients already diagnosed with preeclampsia. Now there is a new blood test which uses cell free RNA, drawn between 18 and 22 weeks of gestation, which can also predict preterm preeclampsia. Does this work? And what do we do when the result shows “high risk” It's a complicated issue. We have to be careful what we ask for. Listen in for details!1. https://publications.smfm.org/publications/554-acog-clinical-practice-update-biomarker-prediction-of-preeclampsia/2. ACOG Clinical Practice Update: Biomarker Prediction of Preeclampsia With Severe Features June 20243. https://www.healthywomen.org/tech-talk-hp/tools-to-predict-preeclampsia4. Elovitz, M.A., Gee, E.P.S., Delaney-Busch, N. et al. Molecular subtyping of hypertensive disorders of pregnancy. Nat Commun 16, 2948 (2025). https://doi.org/10.1038/s41467-025-58157-y5. https://www.businesswire.com/news/home/20250717476669/en/New-Study-in-JAMA-Network-Open-Shows-Current-Approaches-to-Assessing-Preeclampsia-Risk-Are-Failing-the-Majority-of-Pregnant-Moms

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 details.1. Kindelberger DW, Lee Y, Miron A, Hirsch MS, Feltmate C, Medeiros F, Callahan MJ, Garner EO, Gordon RW, Birch C, Berkowitz RS, Muto MG, Crum CP. Intraepithelial carcinoma of the fimbria and pelvic serous carcinoma: Evidence for a causal relationship. Am J Surg Pathol. 2007 Feb;31(2):161-9. 2. ACOG CO 774; 20193. NCCN, Ovarian Cancer Including Fallopian Tube Cancer and Primary Peritoneal Cancer. Updated 2026-03-12.4. ACOG Practice Bulletin No. 147: Lynch Syndrome.Obstetrics and Gynecology. 20145. Falconer H, Yin L, Grönberg H, Altman D. Ovarian cancer risk after salpingectomy: a nationwide population-based study. J Natl Cancer Inst. 2015 Jan 27;107(2):dju410. doi: 10.1093/jnci/dju410. PMID: 25628372.6. Rice MS, Hankinson SE, Tworoger SS. Tubal ligation, hysterectomy, unilateral oophorectomy, and risk of ovarian cancer in the Nurses' Health Studies. Fertil Steril. 2014 Jul;102(1):192-198.e3. doi: 10.1016/j.fertnstert.2014.03.041. Epub 2014 May 10. PMID: 24825424; PMCID: PMC4074555.7. Wilke RN, Pennington KP, Gootzen TA, Steenbeek MP, de Hullu JA, Long KC, Blank SV, Swisher EM, Lu KH, Norquist B. Salpingectomy in individuals at high risk for tubo-ovarian cancer: consensus and precaution. Am J Obstet Gynecol. 2025 Nov 1:S0002-9378(25)00820-8. doi: 10.1016/j.ajog.2025.10.044. Epub ahead of print. PMID: 41183726.

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 plantar fasciitis. The American Medical Society for Sports Medicine notes that PRP is primarily used to treat tendinopathies and osteoarthritis, though clinical efficacy results remain mixed due to variability in PRP formulations and preparation methods. As of now, there are no FDA approved uses for PRP for gynecologic use, although there has been some evidence of possible benefit in vulvar dermatoses and possiblt ovarian function enhancement. But what about its use in the vagina for sexual pleasure? Injecting into the anterior vaginal wall (around the famed G-Spot location) is nothing new. Over a decade ago, a TV show introduced the masses to the “G-Spot amplication” shot which injected collagen to that area. But there was no data for this. Well, we are back to this idea in a new RCT in the Green Journal. Can PRP light up the vaginal fires of pleasure? Listen in for details. 1. Clarke, Bayley MD; Gaddam, Neha MD; Garcia, Bobby MD; Iglesia, Cheryl B. MD; Podolsky, Robert PhD; Dieter, Alexis A. MD. Vaginal Injection of Platelet-Rich Plasma for Sexual Function: A Randomized Controlled Trial. Obstetrics & Gynecology ():10.1097/AOG.0000000000006256, March 19, 2026. | DOI: 10.1097/AOG.00000000000062562. Finnoff JT, Awan TM, Borg-Stein J, et a American Medical Society for Sports Medicine Position Statement: Principles for the Responsible Use of Regenerative Medicine in Sports Medicine. Clinical Journal of Sport Medicine : Official Journal of the Canadian Academy of Sport Medicine. 2021. 3. Alsousou J, Ali A, Willett K, Harrison P. The Role of Platelet-Rich Plasma in Tissue Regeneration.Platelets. 2012.

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 we do when a patient has “two GBS results” in one pregnancy hat are discordant. Listen in for that as well!1. Jaiman S, Romero R, Pacora P, et al. Disorders of Placental Villous Maturation Are Present in One-Third of Cases With Spontaneous Preterm Labor. Journal of Perinatal Medicine. 2021.2. European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2017. Sentilhes L, Sénat MV, Ancel PY, et al. Prevention of Spontaneous Preterm Birth: Guidelines for Clinical Practice From the French College of Gynaecologists and Obstetricians (CNGOF).3. Brink LT, Roberts DJ, Wright CA, et al. Placental Pathology in Spontaneous and Iatrogenic Preterm Birth: Different Entities With Unique Pathologic Features. Placenta. 2022.4. Chitlange SM, Hazari KT, Joshi JV, Shah RK, Mehta AC. Ultrasonographically Observed Preterm Grade III Placenta and Perinatal Outcome.International Journal of Gynaecology and Obstetrics: The Official Organ of the International Federation of Gynaecology and Obstetrics. 1990.5. Mirza FG, Ghulmiyyah LM, Tamim H, et al. To Ignore or Not to Ignore Placental Calcifications on Prenatal Ultrasound: A Systematic Review and Meta-Analysis. The Journal of Maternal-Fetal & Neonatal Medicine : The Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians. 2018.6. Quinlan RW, Cruz AC, Buhi WC, Martin M. Changes in Placental Ultrasonic Appearance. II. Pathologic Significance of Grade III Placental Changes. American Journal of Obstetrics and Gynecology. 1982.7. Karen M. Puopolo Group B Streptococcal Disease. https://orcid.org/0000-0002-5581-8825; Published February 25, 2026 N Engl J Med 2026;394:896-905ACOG 797

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 March 1st, 2026 out of the Green journal. These authors evaluated a prospective cohort (PRESTO cohort) of pregnancy planners to analyze their pregnancy test taking behaviors and their outcomes. The results are eye-opening. So, when is the best time to check a pregnancy test? Listen in for details. 1. Sundermann AC, Jasper EA, Jukic AMZ, Rothman KJ, Wise LA. Pregnancy Test Use and Timing of Pregnancy Detection in a Prospective Cohort of Pregnancy Planners. Obstet Gynecol. 2026 Mar 1;147(3):394-403. doi: 10.1097/AOG.0000000000006157. Epub 2026 Jan 8. PMID: 41505757; PMCID: PMC12788791.2. Wilcox AJ, Baird DD, Dunson D, McChesney R, Weinberg CR. Natural Limits of Pregnancy Testing in Relation to the Expected Menstrual Period. The Journal of the American Medical Association. 2001.

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 our smartphones 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 of print on 03/05/2026 ) is proposing that it may now be able to detect fetal movement, fetal breathing, and even fetal hiccups when placed over the abdomen! Yep, it's not science fiction... it's science innovation. While this is not ready for prime time just yet, the science is absolutely astounding. In this quicky episode we will briefly summarize a fascinating new innovative study which proposes that our iPhones may be able to be a fetal movement detector.1. Moise, Kenneth Jr MD; Gaither, Kelly PhD; Madden-Rusnak, Anna PhD; Lowry, Kathy RN, MSN; Hutson, Emily RN, MSN; Bruns, Danielle RDMS; Valero, Reinaldo MD, RDMS. Smartphone Detection of Fetal Movements Using Artificial Intelligence. Obstetrics & Gynecology ():10.1097/AOG.0000000000006228, March 5, 2026. | DOI: 10.1097/AOG.00000000000062282. Lai J, Woodward R, Alexandrov Y, et al Performance of a Wearable Acoustic System for Fetal Movement Discrimination. PloS One. 2017.3. Ashik AK, Gutierrez R, Ashraf F, et al. A Machine Learning Model for Assessing Fetal Health During Pregnancy. Frontiers in Bioengineering and Biotechnology. 2025.4. Antepartum Fetal Surveillance: ACOG Practice Bulletin, Number 229.Obstetrics and Gynecology. 2021.5. Monitoring a Pregnancy at Home With a Smartphone This wearable device provides real-time ECG monitoring of a fetus: https://spectrum.ieee.org/pregnancy-heartbeat-monitor-smartphone

Neuraxial analgesia (epidural or spinal) combined with tocolytic 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 ask about IV analgesia. A new study in the AJOG (released as an ePub on March 5, 2026) provides some insights that may be helpful for patient consultation. These investigators compared the success of external cephalic version, modes of delivery, maternal pain, and complications using three strategies: intravenous analgesia with remifentanil, epidural anesthesia, and a stepwise approach in which epidural anesthesia was administered only if intravenous analgesia was unsuccessful. Listen in for details.1. ACOG PB 2212. Aiartzaguena, Amaia et al. Comparative effectiveness of intravenous remifentanil, epidural anesthesia and a two-step analgesic approach for external cephalic version: a large prospective single-center cohort study. American Journal of Obstetrics & Gynecology, Volume 0, Issue 03. Hao Q, Hu Y, Zhang L, et a l. A Systematic Review and Meta-Analysis of Clinical Trials of Neuraxial, Intravenous, and Inhalational Anesthesia for External Cephalic Version. Anesthesia and Analgesia. 2020. 4. Wilson MJA, MacArthur C, Hewitt CA, et al.5. Intravenous Remifentanil Patient-Controlled Analgesia Versus Intramuscular Pethidine for Pain Relief in Labour (RESPITE): An Open-Label, Multicentre, Randomised Controlled Trial. Lancet. 2018.

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 Indianapolis released findings from a secondary analysis of the IMPROVE trial (2019, AJOG) looking at the effect of obesity on buccal vs vaginal doses of misoprostol for cervical ripening. Listen in for details.1. Haas DM, Daggy J, Flannery KM, Dorr ML, Bonsack C, Bhamidipalli SS, Pierson RC, Lathrop A, Towns R, Ngo N, Head A, Morgan S, Quinney SK. A comparison of vaginal versus buccal misoprostol for cervical ripening in women for labor induction at term (the IMPROVE trial): a triple-masked randomized controlled trial. Am J Obstet Gynecol. 2019 Sep;221(3):259.e1-259.e16. doi: 10.1016/j.ajog.2019.04.037. Epub 2019 May 7. PMID: 31075246; PMCID: PMC7692024.2. ACOG July 2025: Cervical Ripening in Pregnancy, ACOG Clinical Practice Guideline No. 93. Bynarowicz, Taylor M. et al. The impact of body mass index on misoprostol dosing for labor induction: a comparison of vaginal and buccal dosage formsAmerican Journal of Obstetrics & Gynecology, Volume 0, Issue 0: https://www.ajog.org/article/S0002-9378(26)00126-2/fulltext4. Etrusco A, Sfregola G, Zendoli F, et al. Effect of Maternal Age and Body Mass Index on Induction of Labor Using Oral Misoprostol in Late-Term Pregnancies: A Retrospective Cross-Sectional Study. Gynecologic and Obstetric Investigation. 2024. 5. Prostaglandin Versus Mechanical Dilation and the Effect of Maternal Obesity on Failure to Achieve Active Labor: A Cohort Study.6. Beckwith L, Magner K, Kritzer S, Warshak CR. The Journal of Maternal-Fetal & Neonatal Medicine : The Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians. 2017.

Quickie #2: Can a Virgin Get BV?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 of Therapies. Current Opinion in Infectious Diseases. 2026.2. Liu D, Zhang X, Zhao X, et al. Bacterial Vaginosis: Advancing Insights Into Microbial Dysbiosis. Critical Reviews in Microbiology. 2026.3. Verstraelen H, Verhelst R, Vaneechoutte M, Temmerman M. The Epidemiology of Bacterial Vaginosis in Relation to Sexual Behaviour. BMC Infectious Diseases. 2010.4. Verstraelen H, Verhelst R, Vaneechoutte M, Temmerman M. The Epidemiology of Bacterial Vaginosis in Relation to Sexual Behaviour. BMC Infectious Diseases. 2010.

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, azithromycin has largely replaced erythromycin in PPROM management due to supply shortages and tolerability. Previous retrospective studies (2019) have found no difference in latency between single-dose and multi-day azithromycin regimens, but these studies did not measure actual drug concentrations at the site of action. In that 2019 retrospective study, there was also no difference in incidence of chorioamnionitis, or neonatal outcomes when comparing different dosing regimens of the azithromycin with erythromycin, with the exception of respiratory distress syndrome being more common in the 5 day azithromycin group. However, a 2024 single-center, retrospective study from Annals Pharmacotherapy found significantly higher rates of histologic chorioamnionitis with single-dose azithromycin compared to 5-day regimens (62.6% vs 46.4%, P=0.006), despite similar latency periods. So, it’s complicated. A 2025 systematic review of international guidelines found that 6 out of 17 clinical practice guidelines acknowledged uncertainty about the optimal antibiotic regimen. This was published in the AJOG. In this episode, we will review a new publication from March 2026 in the AJOG which sought to compare the pharmacokinetic parameters of 1 g once vs 500 mg daily dosing of azithromycin in the setting of preterm prelabor rupture of membranes and simulate various dosing regimens to identify the optimal regimen that maintains amniotic fluid concentration of azithromycin over the minimum inhibitory concentration of common GU pathogens associated with intraamniotic infection or inflammation. But there is a BIG limitation. Listen in for details.1. Navathe R, Schoen CN, Heidari P, Bachilova S, Ward A, Tepper J, Visintainer P, Hoffman MK, Smith S, Berghella V, Roman A. Azithromycin vs erythromycin for the management of preterm premature rupture of membranes. Am J Obstet Gynecol. 2019 Aug;221(2):144.e1-144.e8. doi: 10.1016/j.ajog.2019.03.009. Epub 2019 Mar 20. PMID: 30904320.2. Kua S, Roman A, Harbinson L, Groom K, Whitehead C. Systematic review of national and international clinical practice guidelines for management of preterm prelabor rupture of membranes. Am J Obstet Gynecol. 2025 Nov 22:S0002-9378(25)00866-X. 3. Day KN, Vircks JA, Henricks CE, Reaves KM, Holmes AK, Florio KL. Latency Antibiotics in Preterm Prelabor Rupture of Membranes: A Comparison of Azithromycin Regimens. Ann Pharmacother. 2024 Mar;58(3):234-240. doi: 10.1177/10600280231181135. Epub 2023 Jun 26. PMID: 38124306.4. Boelig, Rupsa C. et al. Azithromycin in preterm premature rupture of membranes: population pharmacokinetics and dose optimization. American Journal of Obstetrics & Gynecology, March 2026. SPONSER SITE: Visit www.perspectivemedical for more information on the Hemorrhage View C-Section Drape