Dr. Chapa’s OBGYN Clinical Pearls

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 associated with these practices. Join us as we unpack the motivations behind these choices, the lack of evidence supporting their safety, and the serious harms that can arise for both parent and baby. We'll be examining medical guidelines, and real-world consequences to provide a comprehensive and nuanced understanding of this complex issue. It’s a balance between patient autonomy, advocacy, and potentially allowing an atrocity. Listen in for details. 1. Apr 20, 2020 ACOG Statement on Birth Settings: https://www.acog.org/news/news-releases/2020/04/acog-statement-on-birth-settings2. Planned Home Birth ACOG CO 6973. https://www.theguardian.com/world/ng-interactive/2025/nov/22/free-birth-society-linked-to-babies-deaths-investigation4. https://birthguidechicago.com/wp-content/uploads/2018/07/home_births_rcog_rcm0607.pdf

In 2024, the ASCCP updated their guidance to include DualStain technology as part of primary HPV cervical cancer screening. Now, on December 4, 2025, the ACS has updated their guidance regarding patient self-collectionof vaginal specimens for primary HPV screening. This is fascinating and proves medicine moves fast! Should a negative self-collection test result have a repeatscreen in 1, 3 or 5 years, or later? Listen in for details.1.     Self-collected vaginal specimens for humanpapillomavirus testing and guidance on screening exit: An update to theAmerican Cancer Society cervical cancer screening guideline2.     https://open.spotify.com/episode/5x4J3TQJPdkHtV9RLTUi5oSTRONG COFFEE PROMO:https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

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 Jørgen Løvset in the 1940s. Now, in the current November 2025 AJOG, this maneuver is back in the spotlight. In this episode, we will review the reverse Løvset maneuver for shoulder dystocia and review its effectiveness. Which maneuver is more likely to result in fetal brachial plexus injury? Listen in for details. 1. A critical evaluation of the external and internal maneuvers for resolution of shoulder dystocia, March 2024; AJOG. https://www.ajog.org/article/S0002-9378(23)00022-4/fulltext2. Grindheim, Sindre et al.Reverse Løvset maneuver for shoulder dystocia, American Journal of Obstetrics & Gynecology, Volume 233, Issue 5, 505.e1 - 505.e43. Leung TY, Stuart O, Suen SS, Sahota DS, Lau TK, Lao TT. Comparison of perinatal outcomes of shoulder dystocia alleviated by different type and sequence of manoeuvres: a retrospective review. BJOG. 2011 Jul;118(8):985-90. doi: 10.1111/j.1471-0528.2011.02968.x. Epub 2011 Apr 12. PMID: 21481159.4. Grobman WA, Miller D, Burke C, Hornbogen A, Tam K, Costello R. Outcomes associated with introduction of a shoulder dystocia protocol. Am J Obstet Gynecol. 2011;205(6):513−517.STRONG COFFEE PROMO CODE:https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

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 augmentlabor, 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 declines Pitocin while asking or oral misoprostol, can that be used? Is that evidence-based? The data may surprise you. Listen in for details. 1.     SOGC Guideline No. 432c: Induction of Labour Robinson,Debbie Campbell, Kim Hobson, Sebastian R. MacDonald, W. Kim Sawchuck, DianeWagner, Brenda et al. Journal of Obstetrics and Gynaecology Canada , Volume 45, Issue 1, 70 - 77.e32.     Bracken H, Lightly K, Mundle S, et al. OralMisoprostol Alone Versus Oral Misoprostol Followed by Oxytocin for Labour Induction in Women With Hypertension in Pregnancy (MOLI): Protocol for a Randomised Controlled Trial. BMC Pregnancy and Childbirth. 2021;21(1):537.doi:10.1186/s12884-021-04009-8.3.     Bleich AT, Villano KS, Lo JY, et al. OralMisoprostol for Labor Augmentation: A Randomized Controlled Trial. Obstetrics and Gynecology. 2011;118(6):1255-1260. doi:10.1097/AOG.0b013e318236df5b.4.     Ho M, Cheng SY, Li TC. Titrated Oral MisoprostolSolution Compared With Intravenous Oxytocin for Labor Augmentation: A Randomized Controlled Trial. Obstetrics and Gynecology. 2010;116(3):612-618. doi:10.1097/AOG.0b013e3181ed36cc. STRONG COFFEE PROMO CODE:https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

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 higher or lower depending on the type of IUD; for example, copper IUDs have been associated with rates up to 20%, while levonorgestrel-releasing IUDs show lower rates around 2.9%. In women with an IUD, who are found to have this finding on their liquid-based Pap smear, what is the appropriate management? In this episode, which comes from one of our podcast family members, we will discuss this topic and it’s management in both symptomatic and symptomatic (pelvic pain) IUD wearing women. 1. McHugh KE, Sturgis CD, Procop GW, Rhoads DD. The Cytopathology of Actinomyces, Nocardia, and Their Mimickers. Diagnostic Cytopathology. 2017;45(12):1105-1115. doi:10.1002/dc.23816.2. Practice Bulletin No. 186: Long-Acting Reversible Contraception: Implants and Intrauterine Devices. Obstetrics and Gynecology. 2017;130(5):e251-e269. doi:10.1097/AOG.0000000000002400.3. Miller JM, Binnicker MJ, Campbell S, et al. Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2024 Update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 2024; ciae104. doi:10.1093/cid/ciae104.5. Carrara J, Hervy B, Dabi Y, et al. Added-Value of Endometrial Biopsy in the Diagnostic and Therapeutic Strategy for Pelvic Actinomycosis. Journal of Clinical Medicine. 2020;9(3):E821. doi:10.3390/jcm9030821.

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 unexplained RPL? Is that evidence-based? A new publication from the SMFM’s journal Pregnancy has examined this. Listen in for details. 1. 22 November 2025: Low-dose aspirin in unexplained recurrent pregnancy loss: A systematic review and meta-analysis (Pregnancy): https://obgyn.onlinelibrary.wiley.com/doi/10.1002/pmf2.700992. American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice, T. Flint Porter, Cynthia Gyanff-Bannerman, Tracy Manuck. Low-Dose Aspirin Use During Pregnancy. American College of Obstetricians and Gynecologists (2018)3. Naimi AI, Perkins NJ, Sjaarda LA, et al. The Effect of Preconception-Initiated Low-Dose Aspirin on Human Chorionic Gonadotropin-Detected Pregnancy, Pregnancy Loss, and Live Birth : Per Protocol Analysis of a Randomized Trial. Annals of Internal Medicine. 2021;174(5):595-601. doi:10.7326/M20-0469.4. Lee EE, Jun JK, Lee EB.Management of Women With Antiphospholipid Antibodies or Antiphospholipid Syndrome During Pregnancy. Journal of Korean Medical Science. 2021;36(4):e24. doi:10.3346/jkms.2021.36.e24.5. 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.

A recent discussion tackles the controversial practice of changing surgical gloves after placental delivery during C-sections. While a November 2025 UK study supports this glove change to reduce surgical site infections, major U.S. organizations like ACOG and CDC do not recommend it. The episode dives into the discrepancy between international guidelines and U.S. practices, explores the rationale for glove changes, and emphasizes the need for further high-quality trials to validate claims. Clinicians are encouraged to consider a flexible approach based on local reviews.

Discover the intricate world of muscular dystrophy, particularly Duchenne and myotonic forms. Learn about the significance of prenatal carrier screening and its role in identifying risks. Dr. Chapa dives into the genetics and varying severity of these conditions, shedding light on manifesting carriers and their cardiac health. The episode offers insights on dystrophin's function and explores follow-up protocols for carriers, emphasizing the importance of monitoring and counseling. A deep dive into genetics that enlightens and educates!

The podcast dives into the evolving debate on anesthesia for cesarean sections. It reveals that approximately one in six women may experience pain with regional anesthesia. A recent meta-analysis suggests general anesthesia might be a valid elective option. Concerns about maternal mental health and potential developmental impacts on children are explored, highlighting links to postpartum depression. Practical factors for choosing anesthesia are also discussed, making it a comprehensive look at the challenges and considerations in delivering care.

Explore the intriguing debate surrounding lidocaine patches for post-cesarean pain relief. Discover how recent meta-analyses weigh the effectiveness of these patches against opioid use and overall patient satisfaction. Dr. Chapa dives into systematic reviews, revealing mixed outcomes and the role of patches as an adjunct to multimodal analgesia. Find out what the latest data suggests about pain improvement and their practical limitations in a clinical setting.