Dr. Chapa’s OBGYN Clinical Pearls

Sometimes you hear something that makes you just stop and say, “What did you say?!”. Yep, in this episode we will give evidence-based answers to three questions that I heard TODAY that made me stop and ask, “What did you say?”. In this episode we will cover: 1. Umbilical cord blood collection from a monochorionic twin gestation, 2. Predictability of the mBPP compared to full BPP, and 3. Breastfeeding during postpartum cannabis use (this last one is not so intuitive as you would think, and there is new ACOG guidance on this which we will review). Listen in for details!1. ACOG PB 229; 20212. ACOG CC #10: Cannabis Use During Pregnancy and Lactation3. Kaufman DA, Lucke AM, Cummings JJ. Postnatal Cord Blood Sampling: Clinical Report.Pediatrics. 2025;155(6):e2025071811. doi:10.1542/peds.2025-071811.4. Simpson L, Khati NJ, Deshmukh SP, et al. ACR Appropriateness Criteria Assessment of Fetal Well-Being. Journal of the American College of Radiology : JACR. 2016;13(12 Pt A):1483-1493. doi:10.1016/j.jacr.2016.08.028.STRONG COFFEE PROMO: 20% Off Strong Coffee Company https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

Explore the latest insights on HPV vaccination recommendations and the evolving landscape of cervical cancer prevention. Discover ACOG's 2023 guidance on adjuvant HPV vaccination for patients aged 27–45 and the intriguing results from the VACCIN trial, which challenge previous findings on recurrence rates of cervical dysplasia. Delve into the difference between clinical and statistical significance and how these findings may affect guidelines and patient discussions. Join a conversation on the importance of continuous re-evaluation in medicine as new evidence emerges.

FYI

A breakthrough discovery in the 1970s was the determination of alpha-fetoprotein levels in the serum of pregnant women to detect fetuses with neural tube defects. In the case of high AFP values in maternal serum, amniocentesis was performed to determine the levels of AFP and acetylcholinesterase (AChE) in the amniotic fluid to confirm the diagnosis. Currently, the ACOG states that high-quality, second-trimester fetal anatomy ultrasonography is an appropriate screening test for NTDs where routinely performed for fetal anatomic survey at 18 to 22 weeks. If optimal images of the fetal spine, intracranial anatomy, or anterior abdominal wall are not obtained (eg, fetal position or maternal obesity), MSAFP should be performed to improve detection of NTDs (ACOG Practice Bulletin No. 187: Neural Tube Defects. Committee on Practice Bulletins Obstet Gynecol. 2017). Some clinicians (as we do in our practice) order both fetal anatomy ultrasound and msAFP concurrently. What are the implications when the msAFP is elevated with a normal fetal anatomical survey? Where is this msAFP coming from? Listen in for details.1. ACOG Practice Bulletin No. 187: Neural Tube Defects. Committee on Practice Bulletins Obstet Gynecol. 20172. Pregnancy Outcomes Regarding Maternal Serum AFP Value in Second Trimester Screening. Bartkute K, Balsyte D, Wisser J, Kurmanavicius J. Journal of Perinatal Medicine. 2017;45(7):817-820. doi:10.1515/jpm-2016-0101.3. Głowska-Ciemny J, Szmyt K, Kuszerska A, Rzepka R, von Kaisenberg C, Kocyłowski R. Fetal and Placental Causes of Elevated Serum Alpha-Fetoprotein Levels in Pregnant Women. J Clin Med. 2024 Jan 14;13(2):466. doi: 10.3390/jcm13020466. PMID: 38256600; PMCID: PMC10816536.STRONG COFFEE PROMO: 20% Off Strong Coffee Company https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

The only structure of fetal gastrointestinal tract (GIT) which is seen on routine second trimester anomaly scan is the fetal stomach. Under normal conditions, the fetal stomach "bubble" is seen on the left side of the fetal abdomen. This is a normal finding on an ultrasound and indicates the stomach's normal position. There are two functions of the fetal GIT: 1. Propulsive action by peristalsis which takes the swallowed amniotic fluid up to the small bowel; 2. Absorption – the amniotic fluid is absorbed through the fetal small bowel. When the stomach is found prenatally to be located on the right side, it is called dextrogastria. Today in our high-risk prenatal clinic, we encountered a patient whose fetus was found to have this rare condition dextrogastria. Is this an isolated issue? What does this mean for clinical outcomes. Listen in for details.1. Versteegh HP, Adams SD, Boxall S, Burge DM, Stanton MP. Antenatally diagnosed right-sided stomach (dextrogastria): A rare rotational anomaly. J Pediatr Surg. 2016 Feb;51(2):236-9. doi: 10.1016/j.jpedsurg.2015.10.060. Epub 2015 Nov 4. PMID: 26655213.2. A Case Report Of An Isolated Dextrogastria Diagnosed In First Trimester Ultrasound Screening: https://hjog.org/?p=35403. Docx MKF, Steylemans A, Govaert PIsolated dextrogastria in a newbornArchives of Disease in Childhood - Fetal and Neonatal Edition 2015;100:F513.4. https://www.researchgate.net/publication/43349867_Isolated_dextrogastria_A_case_report5. Aziz, S., König, S., Noor, H. et al. Isolated dextrogastria with eventration of right hemidiaphragm and hiatal hernia in an adult male. BMC Gastroenterol 22, 56 (2022). https://doi.org/10.1186/s12876-022-02127-x

Explore the fascinating history of C-Sections, as even Shakespeare referenced them! Discover new research indicating that a labored primary C-Section increases the risk of placenta accreta in future pregnancies. Delve into surprising statistics about intraoperative pain during C-Sections, revealing rates from 1.4% to a shocking 36%. This crucial discussion emphasizes the importance of understanding patient experiences and managing pain effectively to improve outcomes.

Just today in clinic, we had a patient, who was well into her third trimester, come to her regular scheduled appointment with new onset left-sided facial droop. Yeah, that’s concerning! A complete history and physical was performed and the diagnosis was made of Bell’s palsy. This is not a rare event and it can be extremely stressful for the affected mother to be because everybody knows facial droop is not normal! And we have recent data regarding this. In July 2025 in the Journal of Plastic, Reconstructive, and Aesthetic Surgery, authors confirmed that Bell’s palsy can have real negative functional and psychosocial implications for those affected. So, in this episode, we are going to discuss Bell’s palsy in pregnancy. How do we differentiate this from the more serious differential, which is a stroke? What about treatment? Listen in for details. 1. Wesley, Shaun R. MD; Vates, G. Edward MD, PhD; Thornburg, Loralei L. MD. Neurologic Emergencies in Pregnancy. Obstetrics & Gynecology 144(1):p 25-39, July 2024. | DOI: 10.1097/AOG.00000000000055752. Vrabec JT, Isaacson B, Van Hook JW. Bell's Palsy and Pregnancy.Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery. 2007;137(6):858-61. doi:10.1016/j.otohns.2007.09.009.3. Evangelista V, Gooding MS, Pereira L.Bell's Palsy in Pregnancy.Obstetrical & Gynecological Survey. 2019;74(11):674-678. doi:10.1097/OGX.00000000000007324. JPRAS (July 2025): https://www.jprasurg.com/article/S1748-6815(25)00328-6/fulltextSTRONG COFFEE PROMO: 20% Off Strong Coffee Company https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

Maternal concerns about decreased fetal movement can be alarming, affecting up to 15% of pregnancies. The podcast delves into why routine labor induction isn't recommended solely for this issue. The discussion highlights the cerebroplacental ratio (CPR) as a potential ultrasound tool for assessing fetal well-being and early placental insufficiency. The results of the CEPRA trial suggest the CPR could influence clinical practice, though caution is advised since routine induction may not improve outcomes. Practical guidance is emphasized throughout.

Explore the evolution of electronic fetal monitoring from the 1960s to today, highlighting its role in intrapartum care despite limitations. Discover three key points from the upcoming ACOG guidelines, including the relevance of intermittent fetal auscultation. Delve into maternal oxygen use for fetal resuscitation and the emerging potential of AI in fetal heart rate assessments. The discussion underscores gaps in evidence while emphasizing best practices for monitoring and resuscitation.

Dive into the impact of insomnia on pregnancy with insights from the latest JAMA study. Explore how sleep disorders like obstructive sleep apnea can lead to serious risks such as ischemic placental disease. Discover the implications of night shift work and altered circadian rhythms on maternal and fetal health. The discussion also covers practical strategies for managing insomnia during pregnancy, including relaxation techniques and the potential benefits of melatonin. Tune in for essential information for expecting moms!