Dr. Chapa’s OBGYN Clinical Pearls

Polyhydramnios may be due to excess urine production or impaired fetal swallowing. The ACOG CO 831 states that mild, idiopathic polyhydramnios may be delivered at 39 weeks and 0 days and thereafter, but there is no specific mention regarding moderate to severe poly. In this episode we will cover delivery of moderate to severe poly. Is that data in SMFM consult series 46 (Evaluation and management of polyhydramnios)? The answer is both YES and NO. Listen in for details.1. ACOG CO 8312. SMFM CS 463. https://med.uc.edu/docs/default-source/obstetrics-and-gynecology-docs/ob-mfm-protocols/a-d/isolatd-amniotic-fluid-disorders.pdf?sfvrsn=75dc58e4_4

What’s best for skin closure at C-Section? Staples or suture? This debate has raged for over 20 years. Past data has shown greater odds of wound complications with metal staples compared to suture. But new a meta-analysis from June 2025 is challenging the prior results. In this episode, we will explore the data from 2010 to present day. PLUS, we will summarize a separate meta-analysis examining if wound dressing removal is tied to any wound complication. This was just published July 15, 2025 in the “Pink” journal. Listen in for details. 1. 2010: Basha SL, Rochon ML, Quiñones JN, Coassolo KM, Rust OA, Smulian JC. Randomized controlled trial of wound complication rates of subcuticular suture vs staples for skin closure at cesarean delivery. Am J Obstet Gynecol. 2010 Sep;203(3):285.e1-8. doi: 10.1016/j.ajog.2010.07.011. PMID: 20816153.2. 2015: Mackeen AD, Schuster M, Berghella V. Suture versus staples for skin closure after cesarean: a metaanalysis. Am J Obstet Gynecol. 2015 May;212(5):621.e1-10. doi: 10.1016/j.ajog.2014.12.020. Epub 2014 Dec 19. PMID: 25530592.3. Jan 2025: Gabbai D, Jacoby C, Gilboa I, Maslovitz S, Yogev Y, Attali E. Comparison of complications and surgery outcomes in skin closure methods following cesarean sections. Arch Gynecol Obstet. 2025 Jul;312(1):125-129. doi: 10.1007/s00404-024-07911-6. Epub 2025 Jan 25. PMID: 39862268; PMCID: PMC12176926.4. June 2025: Post-cesarean skin closure with metal staples versus subcuticular suture in obese patients: A systematic review and meta-analysis of randomized controlled trials. Luis Sanchez-Ramos et al (Univ Florida). https://onlinelibrary.wiley.com/doi/pdf/10.1002/pmf2.700615. DRESSING REMOVAL: July 15, 2025: Leshae A Cenac, Serena Guerra, Alicia Huckaby, Gabriele Saccone, Vincenzo Berghella. Early Wound Dressing (soft gauze/tape dressing) Removal after Cesarean Delivery: A Meta-Analysis of Randomized Trials: Short title: early wound dressing removal after cesarean, American Journal of Obstetrics & Gynecology MFM, 2025; https://doi.org/10.1016/j.ajogmf.2025.101739.6. https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf

Is it beneficial to continue low-dose aspirin postpartum for preeclampsia prevention? New research sheds light on this clinical question. The podcast delves into a randomized clinical trial linking postpartum aspirin use to maternal cardiac health, specifically NT-proBNP levels. While findings suggest that continuing aspirin may not show immediate benefits, it raises important discussions about its effects during pregnancy. Listeners will gain insights into recent publications enhancing their understanding of aspiring treatment strategies.

Amniotic Fluid Sludge (AFS) has been theorized to be sonographic evidence of an underlying infection/inflammation. Others have proposed it may represent an organized clot from the placental surface. At the same time, the finding of AFS may be more common as a benign finding especially at/after 40 weeks as the amniotic fluid accumulates shed skin cells, vernix, and possibly meconium past 41 weeks. What can be tell the patient when we identify AFS in the early second trimester? What do we do with this? In this episode, we will summarize the data on second trimester AFS and review the evidence-based “next steps” in care. Does this require empiric antibiotic therapy in the asymptomatic patient? Listen in for details. 1.     Zimmer EZ, Bronshtein M. Ultrasonic features ofintra-amniotic "unidentified debris' at 14-16 weeks' gestation. UltrasoundObstet Gynecol. 1996 Mar;7(3):178-81. doi: 10.1046/j.1469-0705.1996.07030178.x.PMID: 8705409.2.     Luca S-T, Săsăran V, Muntean M, Mărginean C. AReview of the Literature: Amniotic Fluid “Sludge”—Clinical Significance andPerinatal Outcomes. Journal of Clinical Medicine. 2024; 13(17):5306. https://doi.org/10.3390/jcm131753063.     Sapantzoglou I, Pergialiotis V, Prokopakis I,Douligeris A, Stavros S, Panagopoulos P, Theodora M, Antsaklis P, Daskalakis G.Antibiotic therapy in patients with amniotic fluid sludge and risk of pretermbirth: a meta-analysis. Arch Gynecol Obstet. 2024 Feb;309(2):347-361. doi:10.1007/s00404-023-07045-1. Epub 2023 Apr 25. PMID: 37097312;

Podcast family, we are in process of an exciting rebrand! Dr. Chapa's Clinical Pearls will soon become our legacy show as we change names and channels to, "Dr. Chapa's OBGYN No Spin Podcast". This will allow us to better align with our mission. Listen in for details and FIND US, as Dr. Chapa's OBGYN No Spin Podcast!!

Intrahepatic Cholestasis of Pregnancy (ICP) has dichotomous effects: Benign for the mother (although the itching it causes may be a qualify of life issue, yet potentially devasting for the child in-utero. In 2021, SMFM released Consult series 53 on the subject. This, together with the ACOG 's CO 831 (Medically Indicated Late Preterm and early term delivery) also from 2021 provide management options for ICP. However, this month- July 2025- Dr. Cynthia Gyamfi-Bannerman et al published a new proposed ICP classification and management schema that is easy to follow. Listen in for details. ​ SMFM CS #53,2021​ ACOG CO #831, 2021​ Sarker M, Ramos GA, Ferrara L, Gyamfi-Bannerman C. Simplifying Management of Cholestasis: A Proposal for a Classification System. Am J Perinatol. 2025 Jul;42(9):1229-1234. doi: 10.1055/a-2495-3553. Epub 2024 Dec 4. PMID: 39631774

Stillbirth is profoundly tragic, affecting 1 in 160 deliveries in the U.S. A new checklist from the Society for Maternal-Fetal Medicine aims to enhance care for pregnancies impacted by stillbirth. The importance of history-taking, fetal autopsy, and advanced genetic testing are crucial in understanding causes. The updated checklist highlights detailed evaluations during delivery, focusing on neonate and placenta assessments. Additionally, evaluating placental health and facilitating timely decision-making are key in managing these sensitive cases.

Postpartum hemorrhage (PPH) is a pressing issue that requires swift assessment through the '4Ts.' New research reveals lasting health risks associated with PPH, including increased cardiovascular disease. Intriguingly, a low-cost, effective method involving a Foley catheter and vacuum suction emerges as a potential game changer. This innovative approach not only offers accessibility but also highlights the importance of early intervention in managing PPH. The conversation dives into practical applications and compelling case studies supporting this method.

The podcast dives into the potential of metformin as a preventive treatment for severe nausea during pregnancy. It highlights a retrospective study showing its ability to reduce hyperemesis gravidarum rates. Safety protocols and the impact of SSRIs on nausea relief are examined, revealing potential risks they pose. There's a focus on metformin dosage, emphasizing careful management due to side effects. Exciting new research sets the stage for future discussions on this important topic!

Discover the complexities of counseling patients with a history of severe perineal tears and their delivery options. The discussion highlights the importance of merging emotional and clinical factors for informed decision-making. Dive into the statistics and long-term consequences of obstetric anal sphincter injuries, and learn about the evolving insights guiding patient choices between vaginal delivery and cesarean sections. This informative session emphasizes the role of education and support for women's health.